Healthcare Provider Details

I. General information

NPI: 1639787740
Provider Name (Legal Business Name): PENTAHEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CREAMERY WAY STE 400
EXTON PA
19341-2551
US

IV. Provider business mailing address

412 CREAMERY WAY STE 400
EXTON PA
19341-2551
US

V. Phone/Fax

Practice location:
  • Phone: 610-594-7590
  • Fax: 610-594-2625
Mailing address:
  • Phone: 610-594-7590
  • Fax: 610-594-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENNIFER SEACE
Title or Position: CREDENTIALING
Credential:
Phone: 610-594-7590