Basic Information
| Provider Information | |||||||||
| NPI: | 1376510164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUTO | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | PETER | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3570 HAMILTON BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181034512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104337481 | ||||||||
| FaxNumber: | 6104333991 | ||||||||
| Practice Location | |||||||||
| Address1: | 3570 HAMILTON BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181034512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104337481 | ||||||||
| FaxNumber: | 6104333991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 12/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS005099L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0818989 | 01 | PA | KEYSTONE CENTRAL | OTHER | 00149306 | 05 | PA | MEDICAID | 07118 | 01 | PA | BS | OTHER | 1000227 | 01 | PA | AMERI HEALTH MERCY | OTHER |