| S Pantelyat Md Pc | |
|
2112 Welsh Rd Philadelphia PA 19115 | |
| (215) 673-1498 | |
| (215) 673-4299 |
| Full Name | S Pantelyat Md Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2112 Welsh Rd, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Susanna Pantelyat (PRESIDENT) |
| Authorized Official Contact | 2156731498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| S Pantelyat Md Pc 2112 Welsh Rd Philadelphia PA 19115 Ph: (215) 673-1498 | S Pantelyat Md Pc 2112 Welsh Rd Philadelphia PA 19115 Ph: (215) 673-1498 |
| NPI Number | 1700981222 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6406848720 |
|---|---|
| Medicare Enrollment ID | O20040330000699 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700981222 | NPI | - | NPPES |
| 30009182 | Other | PA | KEYSTONE MERCY |
| 3226157 | Other | PA | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | MD417337 (Pennsylvania) | Primary |
| 2084N0400X | Psychiatry & Neurology - Neurology | 25MA07382000 (New York) | Secondary |
| Provider Name | Susanna Pantelyat |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679669899 PECOS PAC ID: 0446412720 Enrollment ID: I20120502000593 |
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