Provider Demographics
NPI:1871534909
Name:BITTNER, JUSTIN J (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:J
Last Name:BITTNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4260
Mailing Address - Country:US
Mailing Address - Phone:610-279-1500
Mailing Address - Fax:610-278-6065
Practice Address - Street 1:342 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4260
Practice Address - Country:US
Practice Address - Phone:610-279-1500
Practice Address - Fax:610-278-6065
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008722L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0983190000OtherIBC - PC/KHPE
PA10923215OtherCAQH ID#
PA379042OtherPHCS
PA528278OtherHIGHMARK BLUE SHIELD
PA5754511OtherAETNA PPO
PA2646497OtherAETNA HMO
PA0016053450008Medicaid
PA0983190000OtherAMERIHEALTH/INTERCOUNTY
PA1859552OtherCIGNA HMO/PPO
PA30028991OtherKEYSTONE MERCY
PA16523-OS008722LOtherHEALTH PARTNERS
PA379042OtherPHCS
PA528278GFHMedicare ID - Type UnspecifiedHGSA