Healthcare Provider Details

I. General information

NPI: 1740696194
Provider Name (Legal Business Name): DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 KEYSTONE AVE
CRESSON PA
16630-1214
US

IV. Provider business mailing address

225 KEYSTONE AVE
CRESSON PA
16630-1214
US

V. Phone/Fax

Practice location:
  • Phone: 814-886-2911
  • Fax:
Mailing address:
  • Phone: 814-886-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000