Provider Demographics
NPI:1013204791
Name:ATCHLEY, LANCE CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:CHRISTOPHER
Last Name:ATCHLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:DEPT. OF MEDICINE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4238
Mailing Address - Country:US
Mailing Address - Phone:215-662-3719
Mailing Address - Fax:215-662-7451
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:DEPT. OF MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4238
Practice Address - Country:US
Practice Address - Phone:215-662-3719
Practice Address - Fax:215-662-7451
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-2400207R00000X
PAMT206634207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST-2400OtherMS TEMPORARY TRAIING LICENSE
PAMT206634OtherTEMPORARY MEDICAL LICENSE