Michael Lenneville, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD483842 Issued in PA

Practice address

1431 Nursery St Ste 102
Fogelsville, PA 18051-1612

Phone

(610) 821-4920

NPI assigned

Feb 4, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mlenneville1117837@direct2.lvhn.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lehigh Valley Physician Group

  • Developmental - Behavioral Pediatrics Physician
  • Allentown, PA
  • NPI 1780155689
  Medicare reassignment
• Lehigh Valley Physician Group

  • Family Medicine Physician
  • East Stroudsburg, PA
  • NPI 1245093368
  NPD
• Lehigh Valley Physician Group

  • Transplant Surgery Physician
  • Allentown, PA
  • NPI 1457309650

  Pediatrics

  NPD
• Lehigh Valley Physician Group

  • Family Medicine Physician
  • Mountain Top, PA
  • NPI 1841054285
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1699213132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4076 NEELY ROAD",
            "city": "FORT WAINWRIGHT",
            "state": "AK",
            "postal_code": "99703",
            "telephone_number": "907-361-4835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 NURSERY ST STE 102",
            "city": "FOGELSVILLE",
            "state": "PA",
            "postal_code": "180511612",
            "telephone_number": "610-821-4920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4076 Neely Road",
            "address_purpose": "LOCATION",
            "city": "Fort Wainwright",
            "state": "AK",
            "postal_code": "99703",
            "country_code": "US",
            "telephone_number": "907-361-4835",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LENNEVILLE",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-04",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "31247",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD483842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcy Lynn Krill, PHARM. D
• Jeanne Marie Kuchta
• Deborah Leeck, RN, IBCLC
• Lehigh Valley Physician Group
• Lehigh Valley Physician Group
• Katelyn Suzanne Lindner, D.O.
• Michael C Loomis, CRNA
• Daniel Chan Ly, DO
• Victoria Lynn Martin, PA-C
• Mental-Ease LLC

• Pediatrics Physician in Fogelsville, PA
• Providers in Fogelsville, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.