Provider Demographics
NPI:1124008347
Name:LENTZ, TODD R (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:R
Last Name:LENTZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-479-5070
Mailing Address - Fax:315-701-2525
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1651
Practice Address - Country:US
Practice Address - Phone:315-479-5070
Practice Address - Fax:315-701-2525
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-03-15
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Provider Licenses
StateLicense IDTaxonomies
NY232449-1207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02583773Medicaid
NYRB7612Medicare PIN