=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326480500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA KATHERINE BERG ANTON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2013
-----------------------------------------------------
Last Update Date | 09/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 503 N 21ST ST
-----------------------------------------------------
City | CAMP HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17011-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-972-4448
-----------------------------------------------------
Fax | 717-972-7366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 503 N 21ST ST
-----------------------------------------------------
City | CAMP HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17011-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-972-4448
-----------------------------------------------------
Fax | 717-972-7366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 28515
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | MD474723
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD474723
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------