Provider Demographics
NPI:1114302262
Name:TARA H LAWLOR DERMATOLOGY INC
Entity Type:Organization
Organization Name:TARA H LAWLOR DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAWLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-301-0306
Mailing Address - Street 1:2901 SAINT LAWRENCE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2264
Mailing Address - Country:US
Mailing Address - Phone:610-301-0306
Mailing Address - Fax:610-628-9011
Practice Address - Street 1:2901 SAINT LAWRENCE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2264
Practice Address - Country:US
Practice Address - Phone:610-301-0306
Practice Address - Fax:610-628-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA431362Medicare PIN