Provider Demographics
NPI:1417939745
Name:LEMENTOWSKI, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LEMENTOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EASTGATE AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-1955
Mailing Address - Country:US
Mailing Address - Phone:724-684-7170
Mailing Address - Fax:724-684-7172
Practice Address - Street 1:2 EASTGATE AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1955
Practice Address - Country:US
Practice Address - Phone:724-684-7170
Practice Address - Fax:724-684-7172
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038244L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006293510001Medicaid
069246Medicare ID - Type Unspecified
PA0006293510001Medicaid
X89508Medicare UPIN