Provider Demographics
NPI:1003222134
Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Other - Org Name:CHI EBANDJIEFF / PRKHILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:1060 LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:NANTY GLO
Mailing Address - State:PA
Mailing Address - Zip Code:15943-1232
Mailing Address - Country:US
Mailing Address - Phone:814-749-8624
Mailing Address - Fax:
Practice Address - Street 1:1060 LLOYD ST
Practice Address - Street 2:
Practice Address - City:NANTY GLO
Practice Address - State:PA
Practice Address - Zip Code:15943-1232
Practice Address - Country:US
Practice Address - Phone:814-749-8624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty