Provider Demographics
NPI:1942207089
Name:EHRENBERGER, DONALD (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:EHRENBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S PIKE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9202
Mailing Address - Country:US
Mailing Address - Phone:724-295-2700
Mailing Address - Fax:724-295-2710
Practice Address - Street 1:619 S PIKE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9202
Practice Address - Country:US
Practice Address - Phone:724-295-2700
Practice Address - Fax:724-295-2710
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008488L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1470043OtherHIGHMARK
PA001519274005Medicaid
PA1470043OtherHIGHMARK
PA001519274005Medicaid