Provider Demographics
NPI:1265482038
Name:LEHNERT, RICHARD L (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:LEHNERT
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 1:160 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1319
Mailing Address - Country:US
Mailing Address - Phone:803-351-4393
Mailing Address - Fax:803-351-4393
Practice Address - Street 1:160 FOREST RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1319
Practice Address - Country:US
Practice Address - Phone:803-351-4393
Practice Address - Fax:803-351-4393
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-06-19
Deactivation Date:2008-01-22
Deactivation Code:
Reactivation Date:2013-06-11
Provider Licenses
StateLicense IDTaxonomies
PAOS003125L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA231935286OtherTAX ID
PA0006706070001Medicaid
PA0006706070001Medicaid
PA231935286OtherTAX ID