Provider Demographics
NPI:1548929359
Name:PILLA, JOHN T
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:PILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 8TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1893
Mailing Address - Country:US
Mailing Address - Phone:484-526-2598
Mailing Address - Fax:866-522-4710
Practice Address - Street 1:1521 8TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1893
Practice Address - Country:US
Practice Address - Phone:484-526-2598
Practice Address - Fax:866-522-4710
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner