Basic Information
| Provider Information | |||||||||
| NPI: | 1104801695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELOZIER | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1671 CROOKED OAK DR | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176014207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175695331 | ||||||||
| FaxNumber: | 7175694210 | ||||||||
| Practice Location | |||||||||
| Address1: | 1671 CROOKED OAK DR | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176014207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175695331 | ||||||||
| FaxNumber: | 7175694210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA003630L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.