Provider Demographics
NPI:1679548986
Name:LENAHEN, PATRICK J (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:LENAHEN
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 1:5735 RIDGE AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1745
Mailing Address - Country:US
Mailing Address - Phone:215-482-1141
Mailing Address - Fax:215-482-9758
Practice Address - Street 1:5735 RIDGE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1745
Practice Address - Country:US
Practice Address - Phone:215-482-1141
Practice Address - Fax:215-482-9758
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033940E208800000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01247521Medicaid
PA232563743OtherITIN
PA424109Medicare ID - Type Unspecified
PAE52784Medicare UPIN