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General NPI Number Information
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NPI Number | 1457796823
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Entity Type | Organization
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Legal Business Name | LIGONIER GYNECOLOGY LLC
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 113 S FAIRFIELD ST
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City | LIGONIER
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State | PA
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Zip | 15658-1163
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Country | US
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Telephone | 724-691-6489
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Fax |
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Provider Business Mailing Address
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Address Line | 513 ROUTE 259
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City | LIGONIER
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State | PA
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Zip | 15658-2468
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Country | US
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Telephone | 724-691-6489
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. DIANA F DENNING
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Credential | M.D.
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Telephone | 724-691-6489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | MD-067284-L
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License Number State | PA
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