Provider Demographics
NPI:1922084805
Name:DIRENZO, DENNIS P (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:P
Last Name:DIRENZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 BERKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1224
Mailing Address - Country:US
Mailing Address - Phone:610-374-7400
Mailing Address - Fax:610-374-4252
Practice Address - Street 1:40 BERKSHIRE CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1224
Practice Address - Country:US
Practice Address - Phone:610-374-7400
Practice Address - Fax:610-374-4252
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028331E2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0953273Medicaid
PA0953273Medicaid