Basic Information
| Provider Information | |||||||||
| NPI: | 1629048574 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRONENWETTER | ||||||||
| FirstName: | LOIS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 229 | ||||||||
| Address2: | |||||||||
| City: | EAST PETERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175819356 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2112 HARRISBURG PIKE | ||||||||
| Address2: | SUITE 327 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443216 | ||||||||
| FaxNumber: | 7175443096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 03/31/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD041116E | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208600000X | 04166E | PA | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 001124601 | 05 | PA | MEDICAID |