Provider Demographics
NPI:1629048574
Name:KRONENWETTER, LOIS A (MD)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:A
Last Name:KRONENWETTER
Suffix:
Gender:F
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:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520
Mailing Address - Country:US
Mailing Address - Phone:717-581-9356
Mailing Address - Fax:
Practice Address - Street 1:2112 HARRISBURG PIKE
Practice Address - Street 2:SUITE 327
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3216
Practice Address - Fax:717-544-3096
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041116E207V00000X
PA04166E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001124601Medicaid
PA001124601Medicaid
PA107367ESCMedicare ID - Type Unspecified