Basic Information
| Provider Information | |||||||||
| NPI: | 1487060455 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DLP CONEMAUGH PHYSICIAN PRACTICES LLC | ||||||||
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| OtherOrganizationName: | CONEMAUGH PHYSICIAN GROUP INTERNISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 TECH PARK DR | ||||||||
| Address2: | STE. 1120 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159012515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144758700 | ||||||||
| FaxNumber: | 8144758795 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 TECH PARK DR | ||||||||
| Address2: | STE. 1120 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159012515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144758700 | ||||||||
| FaxNumber: | 8144758795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2014 | ||||||||
| LastUpdateDate: | 07/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | JUDY | ||||||||
| AuthorizedOfficialFirstName: | JESS | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6159207000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.