Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 23857 | NC |
Y | 207VX0201X | Gynecologic Oncologist | 23857 | NC |
NPI | 1154306702 |
---|---|
Provider Name | Samuel Lentz |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27103-1633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 05/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134ER | BCBS (01) | NC |
220636000 | (05) | WV |
4111925 | AETNA (01) | |
6258212 | (05) | VA |
833 | PARTNERS (01) | NC |
89134ER | (05) | NC |
E3697 | MEDCOST (01) | NC |
Q23857 | (05) | SC |