Gantalao, Edgar Bonchita
Gantalao, Edgar Bonchita is an individual health care provider with primary practice located at 635 Maple Ave , Du Bois PA 15801-2376. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Gantalao, Edgar Bonchita can be contacted via phone (814) 375-6379.Contact Information
Primary practice address
635 Maple Ave
Du Bois PA 15801-2376
Phone: (814) 375-6379
Fax: (814) 375-9320
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | MD418498 | Pennsylvania |
Profile Details
| NPI number | 1649200411 |
|---|---|
| LBN Legal business name | Gantalao, Edgar Bonchita |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 4th, 2006 |
| Last updated | Sep 6th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649200411 | NPPES |
| Pennsylvania | MEDICAID | 0019070610006 | |
| Pennsylvania | Other | 001424280 |
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