John Michael Penta, MD
Individual provider Active NPI Otolaryngology Physician · West Reading, PA
NPI 1366440513 · NPPES record last updated Nov 7, 2007
Key facts
- NPI
- 1366440513
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- License
- MD012179E (PA)
- Practice address
- 301 S 7TH Ave
Suite 305
West Reading, PA 19611-1410 - Phone
- (610) 376-6990
- Fax
- (610) 376-6458
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD012179E | PA | MD | Otolaryngology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | MD012179E | PA | Yes |
Addresses
Primary practice location
301 S 7TH Ave
Suite 305
West Reading, PA 19611-1410
Mailing address
301 S 7TH Ave
Suite 305
West Reading, PA 19611-1410
Phone (610) 376-6990
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0006080480001 | Medicaid | PA | |
| 88761 | Other | AETNA | |
| 0019754000 | Other | INDEPENDENCE BLUE CROSS | |
| 01161501 | Other | CAPITAL BLUE CROSS | |
| 174356 | Other | MEDPLUS | |
| 076111 | Other | HIGHMARK BLUE SHIELD | |
| 1505952 | Other | GATEWAY | |
| 20008539 | Other | AMERIHEALTH MERCY | |
| P00309195 | Other | RAILROAD MEDICARE |
Other providers in West Reading, PA
- Bailey Arias Pechner
- Tiany Santana Peguero
- Dennis John Pellecchia
- Vincent A Pellegrini
- Penn State Health Medical Group, LLC
- Sean B Peppard
- Karen A Pescatore
- Erin Marie Pfeffer
- Gordon Phillips
- Gordon Phillips IV
All providers in West Reading, PA · Otolaryngology Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.