Provider Demographics
NPI:1801052147
Name:PONTZER, DOUGLAS (PC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:PONTZER
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2482
Mailing Address - Country:US
Mailing Address - Phone:814-866-4506
Mailing Address - Fax:814-866-4612
Practice Address - Street 1:5100 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2482
Practice Address - Country:US
Practice Address - Phone:814-866-4506
Practice Address - Fax:814-866-4612
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional