Provider Demographics
NPI:1104083716
Name:LORENZ N IANNARONE M.D. P.C.
Entity type:Organization
Organization Name:LORENZ N IANNARONE M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENZ
Authorized Official - Middle Name:N
Authorized Official - Last Name:IANNARONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-947-6616
Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-947-6616
Mailing Address - Fax:215-947-7281
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 318
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-947-6616
Practice Address - Fax:215-947-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023900E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0045131000OtherBLUE CROSS/BLUE SHIELD
PA31520OtherAETNA
PAB36213Medicare UPIN