Healthcare Provider Details

I. General information

NPI: 1578640496
Provider Name (Legal Business Name): JOSEPH LAMANTIA, DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/03/2014
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: DR. JOSEPH LAMANTIA
Title or Position: CEO
Credential: DO
Phone: 724-463-7630