Basic Information
| Provider Information | |||||||||
| NPI: | 1174795744 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONERGAN | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198064047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026560214 | ||||||||
| FaxNumber: | 8772848933 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198064047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026560214 | ||||||||
| FaxNumber: | 8772848933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2008 | ||||||||
| LastUpdateDate: | 04/22/2011 | ||||||||
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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 | 208200000X | 5101017079 | MI | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 2086S0122X | C20008811 | DE | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 208D00000X | C20008811 | DE | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | C20008811 | DE | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 136323YABT | 01 | MEDICARE ID | OTHER |