Basic Information
| Provider Information | |||||||||
| NPI: | 1932515905 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DLP CONEMAUGH PHYSICIAN PRACTICES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CONEMAUGH PHYSICIAN GROUP CRESSON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 2ND ST | ||||||||
| Address2: | |||||||||
| City: | CRESSON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166301141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148862911 | ||||||||
| FaxNumber: | 8148868929 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 2ND ST | ||||||||
| Address2: | |||||||||
| City: | CRESSON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166301141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148862911 | ||||||||
| FaxNumber: | 8148868929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2014 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | TEAGUE | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | AVP, CORPORATE SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6159207000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.