Provider Demographics
NPI:1902057045
Name:BARON T. DENNISTON M.D.
Entity Type:Organization
Organization Name:BARON T. DENNISTON M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARON
Authorized Official - Middle Name:T
Authorized Official - Last Name:DENNISTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-456-1863
Mailing Address - Street 1:150 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1269
Mailing Address - Country:US
Mailing Address - Phone:814-456-1863
Mailing Address - Fax:
Practice Address - Street 1:150 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1269
Practice Address - Country:US
Practice Address - Phone:814-456-1863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044333L103TP0016X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1249105Medicaid
PA678658Medicare PIN
PAE96834Medicare UPIN