Provider Demographics
NPI:1750315420
Name:DENCH, EDWARD HAZLITT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HAZLITT
Last Name:DENCH
Suffix:JR
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:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-0580
Mailing Address - Country:US
Mailing Address - Phone:814-466-7975
Mailing Address - Fax:814-466-7974
Practice Address - Street 1:945 OUTER DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8236
Practice Address - Country:US
Practice Address - Phone:814-466-7975
Practice Address - Fax:814-466-7974
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061646A207L00000X
OH35.035525207L00000X
PAMD033862L2083A0100X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02277800OtherCAPITAL BLUE CROSS
PA2258268000OtherINDEPENDENCE BLUE CROSS
PA0006275440008Medicaid
PA59032OtherHIGHMARK BLUE SHIELD
PA59032OtherHIGHMARK BLUE SHIELD