Healthcare Provider Details

I. General information

NPI: 1205347481
Provider Name (Legal Business Name): PATRICK LELLO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 NORMAN DR
LEBANON PA
17042-7497
US

IV. Provider business mailing address

320 WHEATSTONE LN
LEBANON PA
17042-7672
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-6706
  • Fax:
Mailing address:
  • Phone: 570-954-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA059459
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: