Provider Demographics
NPI:1437279163
Name:LENTZ, JOHN R JR (PA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:LENTZ
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BURNHAM ST
Mailing Address - Street 2:
Mailing Address - City:TURNERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01376-1816
Mailing Address - Country:US
Mailing Address - Phone:413-774-3751
Mailing Address - Fax:
Practice Address - Street 1:8 BURNHAM ST
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376-1816
Practice Address - Country:US
Practice Address - Phone:413-774-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP18258Medicare UPIN
MAAP1354Medicare ID - Type Unspecified