Provider Demographics
NPI:1528240389
Name:LENNON, TINA SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:SUZANNE
Last Name:LENNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15836 SAINT TIMOTHY RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2517
Mailing Address - Country:US
Mailing Address - Phone:914-843-4008
Mailing Address - Fax:
Practice Address - Street 1:15836 SAINT TIMOTHY RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2517
Practice Address - Country:US
Practice Address - Phone:914-843-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNONE207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology