Healthcare Provider Details

I. General information

NPI: 1780672832
Provider Name (Legal Business Name): CHRIS A PATESTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S MOUNTAIN BLVD
MOUNTAIN TOP PA
18707-1122
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-474-5072
  • Fax: 570-474-6941
Mailing address:
  • Phone: 570-474-5072
  • Fax: 570-474-6941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD492956
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: