Healthcare Provider Details

I. General information

NPI: 1316576275
Provider Name (Legal Business Name): JOSEPH PANZERA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 BALTIMORE PIKE
SPRINGFIELD PA
19064-3810
US

IV. Provider business mailing address

51 PETERS RD STE 200
LITITZ PA
17543
US

V. Phone/Fax

Practice location:
  • Phone: 484-470-2600
  • Fax:
Mailing address:
  • Phone: 717-627-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS022459
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberOT020279
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: