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General NPI Number Information
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NPI Number | 1326287855
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Entity Type | Individual
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Provider Name | ERNEST PEVNY M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2009
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 47 SMITHFIELD VLG
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9054
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Country | US
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Telephone | 570-421-2571
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Fax |
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Provider Business Mailing Address
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Address Line | 47 SMITHFIELD VLG
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9054
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Country | US
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Telephone | 570-421-2571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | MD030407E
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License Number State | PA
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