Provider Demographics
NPI:1922003284
Name:LINGENFELTER, KYLE A (MD FACS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:A
Last Name:LINGENFELTER
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HILLCREST DR
Mailing Address - Street 2:STE 2600
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-4121
Mailing Address - Fax:814-938-4158
Practice Address - Street 1:81 HILLCREST DR
Practice Address - Street 2:STE 2600
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2605
Practice Address - Country:US
Practice Address - Phone:814-938-4121
Practice Address - Fax:814-938-4158
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044264L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014589380002Medicaid
PA0014589380002Medicaid
PA763145MT6Medicare PIN