MEDICARE: FRANK R PENATER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD018153E	PA
2	207Q00000X	Family Medicine Physician	MD018153E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063498509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK R PENATER MD

Provider Business Mailing Address
First Line	:	PO BOX 3012
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19804-0012
Country	:	US
Telephone Number	:	800-456-4829
Fax Number	:	302-224-2848

Provider Business Practice Location Address
First Line	:	211 N 12TH ST
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-1138
Country	:	US
Telephone Number	:	810-377-7080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	03/20/2020

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Directions to “ FRANK R PENATER MD” Practice Location

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