Provider Demographics
NPI:1558777995
Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Entity type:Organization
Organization Name:DLP CONEMAUGH PHYSICIAN PRACTICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:564 THEATRE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-7702
Mailing Address - Country:US
Mailing Address - Phone:814-344-8477
Mailing Address - Fax:814-344-2205
Practice Address - Street 1:564 THEATRE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTOWN
Practice Address - State:PA
Practice Address - Zip Code:15722-7702
Practice Address - Country:US
Practice Address - Phone:814-344-8477
Practice Address - Fax:814-344-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health