Doctor Name: | PETER WALTER BRENGEL |
NPI Number: | 1689923195 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | MA055571 |
Business Practice Address: | 341 Story Rd Export, PA - 156322666 |
Business Phone Number: | 7244683999 |
Business Fax Number: | 7244680399 |
Mailing Address: | 341 Story Rd, EXPORT |
State: | PA |
Postal Code: | 156322666 |
Phone Number: | 7244683999 |
Fax Number: | 7244680399 |
NPI Enumeration Date: | 08/30/2012 |
NPI Last Update Date: | 08/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA055571 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |