MEDICARE: S PANTELYAT MD PC

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	2084N0400X	Neurology Physician	25MA07382000	NY
2	2084N0400X	Neurology Physician	MD417337	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30009182	OTHER	PA	KEYSTONE MERCY
2	3226157	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1700981222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S PANTELYAT MD PC

Provider Business Mailing Address
First Line	:	2112 WELSH RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115
Country	:	US
Telephone Number	:	215-673-1498
Fax Number	:	215-673-4299

Provider Business Practice Location Address
First Line	:	2112 WELSH RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115
Country	:	US
Telephone Number	:	215-673-1498
Fax Number	:	215-673-4299

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUSANNA PANTELYAT
Credential	:	MD
Telephone Number	:	215-673-1498

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/22/2020

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Directions to “S PANTELYAT MD PC ” Practice Location

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