Provider Demographics
NPI:1427127729
Name:ENDOCRINE ASSOCIATES OF THE LEHIGH VALLEY PC
Entity type:Organization
Organization Name:ENDOCRINE ASSOCIATES OF THE LEHIGH VALLEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:VENGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-253-9622
Mailing Address - Street 1:5230 WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2966
Mailing Address - Country:US
Mailing Address - Phone:610-253-9622
Mailing Address - Fax:610-253-9772
Practice Address - Street 1:5230 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2966
Practice Address - Country:US
Practice Address - Phone:610-253-9622
Practice Address - Fax:610-253-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA738987OtherBLUE SHIELD
PAAETNAOther0930603
PACN3958OtherRAILROAD MEDICARE
PA02594200OtherCAPITAL BLUE CROSS
PA02594200OtherCAPITAL BLUE CROSS