Healthcare Provider Details

I. General information

NPI: 1891792511
Provider Name (Legal Business Name): KENNETH HOWARD LENTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PROFESSIONAL PLAZA SUITE 206
NORTH CHARLEROI PA
15022
US

IV. Provider business mailing address

2308 HARROW RD
UPPER ST CLAIR PA
15241-2440
US

V. Phone/Fax

Practice location:
  • Phone: 724-489-0900
  • Fax: 724-489-0930
Mailing address:
  • Phone: 412-854-3696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD017947E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: