Provider Demographics
NPI:1871506105
Name:LENTZ, WALTER J (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:LENTZ
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 1:46 WELLS STREET
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891
Mailing Address - Country:US
Mailing Address - Phone:401-596-0124
Mailing Address - Fax:401-596-2266
Practice Address - Street 1:46 WELLS STREET
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891
Practice Address - Country:US
Practice Address - Phone:401-596-0124
Practice Address - Fax:401-596-2266
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIL4973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI90000905Medicaid
RI90000905Medicaid