Healthcare Provider Details

I. General information

NPI: 1295978302
Provider Name (Legal Business Name): SUMMIT PULMONARY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SUMMIT ST
BROOKVILLE PA
15825-1422
US

IV. Provider business mailing address

111 SUMMIT ST
BROOKVILLE PA
15825-1422
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-8329
  • Fax: 814-849-5441
Mailing address:
  • Phone: 814-849-8329
  • Fax: 814-849-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD428157
License Number StatePA

VIII. Authorized Official

Name: DR. TIMOTHY P PENDLETON
Title or Position: PRESIDENT
Credential: M.D., F.C.C.P.
Phone: 814-849-8329