Provider Demographics
NPI:1982098927
Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:236 JAMESWAY RD
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4207
Mailing Address - Country:US
Mailing Address - Phone:814-471-6595
Mailing Address - Fax:814-471-6675
Practice Address - Street 1:236 JAMESWAY RD
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4207
Practice Address - Country:US
Practice Address - Phone:814-471-6595
Practice Address - Fax:814-471-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA363101Medicare PIN