Provider Demographics
NPI:1750364360
Name:OVEDOVITZ, LON A (MD)
Entity type:Individual
Prefix:DR
First Name:LON
Middle Name:A
Last Name:OVEDOVITZ
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213618-1207Q00000X
PAMD065759L207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080159990OtherRR MEDICARE NY PIN
NYCC8362OtherRR MEDICARE GROUP
PAP00099237OtherRR MEDICARE PIN
PAGU039851OtherPA MEDICARE GROUP
PACC9269OtherRR MEDICARE PIN
NYCC2072Medicare PIN
PAP00099237OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
NY080159990OtherRR MEDICARE NY PIN
PAGU039851OtherPA MEDICARE GROUP
NY01927242Medicare ID - Type Unspecified
PACG1637Medicare PIN