Provider Demographics
NPI:1518936624
Name:LENAHAN, R. SEAN (MD)
Entity Type:Individual
Prefix:
First Name:R. SEAN
Middle Name:
Last Name:LENAHAN
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 1:773 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3037
Mailing Address - Country:US
Mailing Address - Phone:215-925-2515
Mailing Address - Fax:
Practice Address - Street 1:334 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1668
Practice Address - Country:US
Practice Address - Phone:865-500-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073899L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1317530OtherHIGHMARK BLUE SHIELD
PA2010572000OtherINDEPENDENCE BLUE CROSS
PA0018659430006Medicaid
PA0018659430006Medicaid
PA2010572000OtherINDEPENDENCE BLUE CROSS