Provider Demographics
NPI:1629099106
Name:LORENZO, DANIEL MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:LORENZO
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 1:918 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7400
Mailing Address - Country:US
Mailing Address - Phone:717-272-7272
Mailing Address - Fax:717-272-0072
Practice Address - Street 1:918 RUSSELL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7400
Practice Address - Country:US
Practice Address - Phone:717-272-7272
Practice Address - Fax:717-272-0072
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425704207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014707840004Medicaid
PA171507YGSYMedicare PIN
PA1014707840004Medicaid