Organization
S PANTELYAT MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSANNA PANTELYAT MD (PRESIDENT)
(215) 673-1498
Entity
Organization
Contact information
Practice address
2112 WELSH RD, PHILADELPHIA, PA 19115
(215) 673-1498
(215) 673-4299
Mailing address
2112 WELSH RD, PHILADELPHIA, PA 19115
(215) 673-1498
(215) 673-4299
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
25MA07382000
NY
2084N0400X
Neurology Physician
Primary
MD417337
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30009182
KEYSTONE MERCY
PA
01
—
3226157
AETNA
PA
Enumeration date
09/13/2006
Last updated
08/22/2020
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