Basic Information
| Provider Information | |||||||||
| NPI: | 1518936624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LENAHAN | ||||||||
| FirstName: | R. SEAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 773 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191473037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159252515 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 E LEHIGH AVE | ||||||||
| Address2: | TEMPLE HOSPITAL EPISCOPAL CAMPUS | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157071656 | ||||||||
| FaxNumber: | 2157070805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 08/30/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD073899L | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1317530 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 2010572000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 0018659430006 | 05 | PA | MEDICAID |