Provider Demographics
NPI:1780653345
Name:LEMERT, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:LEMERT
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 1:799 GAY ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4409
Mailing Address - Country:US
Mailing Address - Phone:610-935-0644
Mailing Address - Fax:610-935-7757
Practice Address - Street 1:799 GAY ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4409
Practice Address - Country:US
Practice Address - Phone:610-935-0644
Practice Address - Fax:610-935-7757
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-012219-E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA107499OtherHIGHMARK BLUE SHIELD
PA0006909220001Medicaid
PA30018354OtherKEYSTONE MERCY
PA3716812OtherAETNA
PA0026038000OtherPERSONAL CHOICE
PA0026038000OtherKEYSTONE HEALTH PLAN EAST
PA107499TGWMedicare ID - Type UnspecifiedMEDICARE
PA0006909220001Medicaid