Provider Demographics
NPI:1366548539
Name:LEMONICK, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:LEMONICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 HORIZON DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3762
Mailing Address - Country:US
Mailing Address - Phone:616-464-0027
Mailing Address - Fax:616-975-9813
Practice Address - Street 1:401 E MURPHY AVE
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-2724
Practice Address - Country:US
Practice Address - Phone:724-628-1500
Practice Address - Fax:724-626-2334
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047254L207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA58603OtherBLUE CROSS/BLUE SHIELD
PAF34221OtherUPIN
PA0013029820003Medicaid
PAP00286240OtherRAILROAD
PAP00286240OtherRAILROAD
PA058603Medicare Oscar/Certification