Provider Demographics
NPI:1134115843
Name:SPLAIN, DENNIS J (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:SPLAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W CHEW ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-663-3441
Mailing Address - Fax:610-663-3170
Practice Address - Street 1:421 W CHEW ST
Practice Address - Street 2:DEPARTMENT OF DIAGNOSTIC RADIOLOGY
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3406
Practice Address - Country:US
Practice Address - Phone:610-776-4822
Practice Address - Fax:610-776-4671
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003950L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
109969OtherHIGHMARK BLUE SHIELD
20021129OtherAMERIHEALTH MERCY NIC
01566701OtherCBC CREST
1090059OtherAMERIHEALTH MERCY CREST
300034751OtherRR MEDICARE CREST
PA0011749620001Medicaid
PA0011749620009Medicaid
01566702OtherCBC NIC
125484OtherUNISON NIC
125483OtherUNISON CREST
0040612000OtherIBC
300121491OtherRR MEDICARE NIC
125484OtherUNISON NIC
PAB36818Medicare UPIN
300121491OtherRR MEDICARE NIC