Healthcare Provider Details

I. General information

NPI: 1568157121
Provider Name (Legal Business Name): REBECCA PETLANSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 TERRY REILEY WAY
POTTSVILLE PA
17901-1774
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-624-4444
  • Fax: 570-624-4445
Mailing address:
  • Phone: 570-624-4444
  • Fax: 570-624-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD493772
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: