Healthcare Provider Details

I. General information

NPI: 1659302297
Provider Name (Legal Business Name): RONNI LYNN LENCER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RONNI LYNN NEEDHAM D.O.

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PINNACLE DR
CLARION PA
16214-3800
US

IV. Provider business mailing address

PO BOX 716 100 SHENANGO AVE.
SHARON PA
16146-0716
US

V. Phone/Fax

Practice location:
  • Phone: 814-223-9900
  • Fax: 814-223-9910
Mailing address:
  • Phone: 814-223-9900
  • Fax: 814-223-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS013479
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1016945900004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: