Provider Demographics
NPI:1194791921
Name:PEDRO, AMBER JULIA (PA-C)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JULIA
Last Name:PEDRO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:JULIA
Other - Last Name:BATTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:217 KING STREET
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:PA
Practice Address - Zip Code:18626-0095
Practice Address - Country:US
Practice Address - Phone:570-946-5101
Practice Address - Fax:570-946-4341
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052953363A00000X
PAOA000766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P60316Medicare UPIN
058248Medicare ID - Type Unspecified