Provider Demographics
NPI:1639178437
Name:LENZ, PATRICK K (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:K
Last Name:LENZ
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 1:792 GALLITZIN ROAD
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630
Mailing Address - Country:US
Mailing Address - Phone:814-886-8161
Mailing Address - Fax:814-886-2955
Practice Address - Street 1:792 GALLITZIN ROAD
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630
Practice Address - Country:US
Practice Address - Phone:814-886-8161
Practice Address - Fax:814-886-2955
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066122L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017111790007Medicaid
PA0017111790005Medicaid
PA056175OtherMEDICARE GROUP PIN
G81369Medicare UPIN
PA0017111790007Medicaid
PA0017111790005Medicaid