Provider Demographics
NPI:1942297965
Name:LENGYEL, ROBERT JOHN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:LENGYEL
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 1:100 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-2116
Mailing Address - Country:US
Mailing Address - Phone:570-282-6485
Mailing Address - Fax:570-281-1256
Practice Address - Street 1:100 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2116
Practice Address - Country:US
Practice Address - Phone:570-282-6485
Practice Address - Fax:570-281-1256
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048081L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001955100Medicaid
H67942Medicare UPIN
PA072621Medicare ID - Type Unspecified