Provider Demographics
NPI:1073171708
Name:MCCRILLIS, LAUREN (DO)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MCCRILLIS
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 1:3039 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9351
Mailing Address - Country:US
Mailing Address - Phone:724-977-5051
Mailing Address - Fax:
Practice Address - Street 1:6900 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:TREXLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18087-9101
Practice Address - Country:US
Practice Address - Phone:610-402-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT01900208000000X
PAOS022258208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics