Healthcare Provider Details

I. General information

NPI: 1811990229
Provider Name (Legal Business Name): LEE E DENLINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W CRESCENT PARK
WARREN PA
16365-2111
US

IV. Provider business mailing address

2 W CRESCENT PARK
WARREN PA
16365-2111
US

V. Phone/Fax

Practice location:
  • Phone: 814-726-0211
  • Fax: 814-723-1078
Mailing address:
  • Phone: 814-726-0211
  • Fax: 814-723-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD16519E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD016519E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: