Provider Demographics
NPI:1730169079
Name:KLYNOWSKY-FARRELL, DENISE MARIE (DO)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:KLYNOWSKY-FARRELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W END RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HANOVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-5448
Mailing Address - Country:US
Mailing Address - Phone:570-208-4035
Mailing Address - Fax:570-208-4038
Practice Address - Street 1:111 W END RD STE 101
Practice Address - Street 2:
Practice Address - City:HANOVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18706-5448
Practice Address - Country:US
Practice Address - Phone:570-208-4035
Practice Address - Fax:570-208-4038
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009866L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017038740009Medicaid
PA0017038740009Medicaid
PA013459V7TMedicare UPIN
PAG76485Medicare UPIN