Basic Information
Provider Information
NPI: 1720245137
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHAL
FirstName: AMITPAL
MiddleName: SINGH
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 N ACADEMY AVE
Address2:  
City: DANVILLE
State: PA
PostalCode: 178229800
CountryCode: US
TelephoneNumber: 5702716405
FaxNumber: 5702716852
Practice Location
Address1: 100 N ACADEMY AVE
Address2:  
City: DANVILLE
State: PA
PostalCode: 178229800
CountryCode: US
TelephoneNumber: 5702716405
FaxNumber: 5702716852
Other Information
ProviderEnumerationDate: 05/22/2008
LastUpdateDate: 06/09/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/09/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100XMD436292PAY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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