1760454326 NPI number — WILLIAM H LENZ DPM

Table of content: WILLIAM H LENZ DPM (NPI 1760454326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760454326 NPI number — WILLIAM H LENZ DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENZ
Provider First Name:
WILLIAM
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LENZ
Provider Other First Name:
WILLIAM
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM, PC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760454326
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 WATERFRONT DR E
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15120-1140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-461-1108
Provider Business Mailing Address Fax Number:
412-461-5490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
495 WATERFRONT DR E
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
HOMESTEAD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15120-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-461-1108
Provider Business Practice Location Address Fax Number:
412-461-5490
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  SC002231L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0008712020002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1156610001 . This is a "DMERC PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004134492 . This is a "AETNA PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 401477XXW . This is a "MC GROUP PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 17109911912 . This is a "GROUP NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1205011277 . This is a "DMERC NPI NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007367 . This is a "GATEWAY HMO INDIV PROV NU" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 401477 . This is a "HIGHMARK INDIVIDUAL PROV#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 455619 . This is a "HIGHMARK GROUP NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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