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10 Timberview Ln # 2 Russell PA 16345-4150 | |
(617) 710-9786 | |
Not Available |
Full Name | |
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Speciality | Internal Medicine |
Location | 10 Timberview Ln # 2, Russell, Pennsylvania |
Authorized Official Name and Position | Dien Viet Le (OWNER) |
Authorized Official Contact | 8147576505 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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10 Timberview Ln # 2 Russell PA 16345-4150 Ph: () - | 10 Timberview Ln # 2 Russell PA 16345-4150 Ph: (617) 710-9786 |
NPI Number | 1730946864 |
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Provider Enumeration Date | 03/05/2024 |
Last Update Date | 05/24/2024 |
Medicare PECOS PAC ID | 0547602674 |
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Medicare Enrollment ID | O20240521003249 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730946864 | NPI | - | NPPES |
104105326-0003 | Medicaid | PA | |
1043213850001 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Dien V Le |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1386095131 PECOS PAC ID: 6305124884 Enrollment ID: I20221109000914 |