Healthcare Provider Details

I. General information

NPI: 1467428979
Provider Name (Legal Business Name): JOSEPH LAMANTIA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 SALTSBURG AVE
INDIANA PA
15701-3525
US

IV. Provider business mailing address

1690 SALTSBURG AVE
INDIANA PA
15701-3525
US

V. Phone/Fax

Practice location:
  • Phone: 724-463-7630
  • Fax: 724-463-7632
Mailing address:
  • Phone: 724-463-7630
  • Fax: 724-463-7632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS012719
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: