Provider Demographics
NPI:1548240195
Name:LENGAUER, TINA (DO)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:LENGAUER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WELLNESS WAY
Mailing Address - Street 2:BLDG 2
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9706
Mailing Address - Country:US
Mailing Address - Phone:724-250-6001
Mailing Address - Fax:724-250-6004
Practice Address - Street 1:100 WELLNESS WAY
Practice Address - Street 2:BLDG 2
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9706
Practice Address - Country:US
Practice Address - Phone:724-250-6001
Practice Address - Fax:724-250-6004
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007264L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01409100Medicaid
PA01409100Medicaid