Healthcare Provider Details

I. General information

NPI: 1639178437
Provider Name (Legal Business Name): PATRICK K. LENZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 GALLITZIN ROAD
CRESSON PA
16630
US

IV. Provider business mailing address

792 GALLITZIN ROAD
CRESSON PA
16630
US

V. Phone/Fax

Practice location:
  • Phone: 814-886-8161
  • Fax: 814-886-2955
Mailing address:
  • Phone: 814-886-8161
  • Fax: 814-886-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD066122L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: