| Doctor Name: | JOHN PONTICIAN |
| NPI Number: | 1346571692 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 553 1st St Port Carbon, PA - 179651721 |
| Business Phone Number: | 5706227785 |
| Business Fax Number: | 5706221774 |
| Mailing Address: | 553 1st St, PORT CARBON |
| State: | PA |
| Postal Code: | 179651721 |
| Phone Number: | 5706227785 |
| Fax Number: | 5706221774 |
| NPI Enumeration Date: | 01/27/2010 |
| NPI Last Update Date: | 01/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171WV0202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | Vehicle Modifications |
| Taxonomy Definition: | A contractor who makes modifications to private vehicles to accommodate a health condition. |