MEDICARE: MOUNTAINTOP PEDIATRICS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	OS014215	PA

General Provider Information

NPI Number	:	1053614008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAINTOP PEDIATRICS PC

Provider Business Mailing Address
First Line	:	PO BOX 1654
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-0654
Country	:	US
Telephone Number	:	570-208-5534
Fax Number	:

Provider Business Practice Location Address
First Line	:	5024 OLD AIRPORT RD
Second Line	:
City	:	HAZLE TOWNSHIP
State	:	PA
Zip	:	18202-3236
Country	:	US
Telephone Number	:	570-450-5025
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IRENE MAN-HSIAO
Credential	:	D.O
Telephone Number	:	347-561-0794

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	04/02/2022

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