Provider Demographics
NPI:1770552762
Name:AMENTA, CIRA L (DO)
Entity type:Individual
Prefix:
First Name:CIRA
Middle Name:L
Last Name:AMENTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S 5TH ST STE 170
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1682
Mailing Address - Country:US
Mailing Address - Phone:267-347-4747
Mailing Address - Fax:267-373-9907
Practice Address - Street 1:127 S 5TH ST STE 170
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1682
Practice Address - Country:US
Practice Address - Phone:267-347-4747
Practice Address - Fax:267-373-9907
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008831L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G40774Medicare UPIN
PA096108Medicare ID - Type Unspecified