Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | C1-0013313 | DE |
N | 207RR0500X | Rheumatology | MD428000 | PA |
NPI | 1124129747 |
---|---|
Provider Name | Douglas Lienesch |
First Address | Newark, DE 19713-2049 |
Second Address | Newark, DE 19713-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 05/09/2019 |