Healthcare Provider Details

I. General information

NPI: 1063498350
Provider Name (Legal Business Name): BARBARA PENETAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 QUINCY AVE
SCRANTON PA
18510-1724
US

IV. Provider business mailing address

PO BOX 390
SCRANTON PA
18501-0390
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-7797
  • Fax: 570-342-9802
Mailing address:
  • Phone: 570-346-7797
  • Fax: 570-342-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number05007899L
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierP00148662
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRR MEDICARE
# 2
Identifier01541767
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: