Individual
JOHN MICHAEL PENTA
Active
Individual
JOHN MICHAEL PENTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD012179E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006080480001
—
PA
01
—
0019754000
INDEPENDENCE BLUE CROSS
—
01
—
01161501
CAPITAL BLUE CROSS
—
01
—
076111
HIGHMARK BLUE SHIELD
—
01
—
1505952
GATEWAY
—
01
—
174356
MEDPLUS
—
01
—
20008539
AMERIHEALTH MERCY
—
01
—
88761
AETNA
—
01
—
P00309195
RAILROAD MEDICARE
—
Enumeration date
07/12/2005
Last updated
11/07/2007
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