Provider Demographics
NPI:1265846539
Name:TENPENNY, DIANA (DO)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:TENPENNY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:BACAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:179 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9207
Mailing Address - Country:US
Mailing Address - Phone:570-426-2330
Mailing Address - Fax:570-426-2331
Practice Address - Street 1:179 INDEPENDENCE RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9207
Practice Address - Country:US
Practice Address - Phone:570-426-2330
Practice Address - Fax:570-426-2331
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09987200207R00000X
PAOS020906207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS020906OtherMEDICAL LICENSE