Healthcare Provider Details

I. General information

NPI: 1194876854
Provider Name (Legal Business Name): JOHN PETER AMENTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 DESSEN CTR 1000ALLIANCE DRIVE
HAZLETON PA
18202-9396
US

IV. Provider business mailing address

1074 FOREST RD
HAZLETON PA
18202-9262
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-1028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD017859E
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: