Provider Demographics
NPI:1497964886
Name:LENKOWSKI, PAUL W JR (MDPHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:LENKOWSKI
Suffix:JR
Gender:M
Credentials:MDPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-342-2193
Practice Address - Street 1:4633 BRAMBLETON AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3410
Practice Address - Country:US
Practice Address - Phone:540-968-7368
Practice Address - Fax:844-212-0402
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247485207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497964886Medicaid
VAP01506899Medicare PIN
VAVVH672AMedicare PIN