Provider Demographics
NPI:1558315077
Name:LEHIGH VALLEY INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:LEHIGH VALLEY INTERNAL MEDICINE, PC
Other - Org Name:CANDIO KOVACS & LAKATA, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CASTAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-402-1051
Mailing Address - Street 1:1230 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6212
Mailing Address - Country:US
Mailing Address - Phone:610-402-1051
Mailing Address - Fax:610-402-1059
Practice Address - Street 1:1230 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6212
Practice Address - Country:US
Practice Address - Phone:610-402-1051
Practice Address - Fax:610-402-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019390E207R00000X
PAMD024168E207R00000X
PAOS008475L207R00000X
PAOS008862L207R00000X
PAOS010005L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA904833OtherBLUE SHIELD
PA02343700OtherCAPITAL BLUE CROSS
PA0376057001OtherKEYSTONE EAST/AMERIHEALTH
PAC31821Medicare UPIN
PAG26774Medicare UPIN
PAG69763Medicare UPIN
PAB40618Medicare UPIN
PA904833Medicare ID - Type UnspecifiedGROUP NUMBER
PAH31884Medicare UPIN