Basic Information
Provider Information
NPI: 1003000530
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEMONCHE
FirstName: AMANDA
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1021 PARK AVE
Address2: SUITE 203
City: QUAKERTOWN
State: PA
PostalCode: 18951
CountryCode: US
TelephoneNumber: 2155367998
FaxNumber:  
Practice Location
Address1: 1021 PARK AVE
Address2: SUITE 203
City: QUAKERTOWN
State: PA
PostalCode: 18951
CountryCode: US
TelephoneNumber: 2155367998
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/28/2007
LastUpdateDate: 09/14/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XOS014260PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
OS01426001PAMEDICAL LICENSE NUMBEROTHER


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