Healthcare Provider Details

I. General information

NPI: 1861808909
Provider Name (Legal Business Name): DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SCALP AVE STE. 003B
JOHNSTOWN PA
15904-3374
US

IV. Provider business mailing address

1450 SCALP AVE STE. 003B
JOHNSTOWN PA
15904-3374
US

V. Phone/Fax

Practice location:
  • Phone: 814-269-9551
  • Fax: 814-266-6263
Mailing address:
  • Phone: 814-269-9551
  • Fax: 814-266-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESS N JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7000