Basic Information
| Provider Information | |||||||||
| NPI: | 1134115843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPLAIN | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 W CHEW ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106633441 | ||||||||
| FaxNumber: | 6106633170 | ||||||||
| Practice Location | |||||||||
| Address1: | 421 W CHEW ST | ||||||||
| Address2: | DEPARTMENT OF DIAGNOSTIC RADIOLOGY | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107764822 | ||||||||
| FaxNumber: | 6107764671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | OS003950L | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 109969 | 01 | HIGHMARK BLUE SHIELD | OTHER | 20021129 | 01 | AMERIHEALTH MERCY NIC | OTHER | 01566701 | 01 | CBC CREST | OTHER | 1090059 | 01 | AMERIHEALTH MERCY CREST | OTHER | 300034751 | 01 | RR MEDICARE CREST | OTHER | 0011749620001 | 05 | PA | MEDICAID | 0011749620009 | 05 | PA | MEDICAID | 01566702 | 01 | CBC NIC | OTHER | 125484 | 01 | UNISON NIC | OTHER | 125483 | 01 | UNISON CREST | OTHER | 0040612000 | 01 | IBC | OTHER | 300121491 | 01 | RR MEDICARE NIC | OTHER |