Provider Demographics
NPI:1144381872
Name:LO, VIVIAN S (MD)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:S
Last Name:LO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:227 LAUREL RD
Mailing Address - Street 2:STE 300
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-8303
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:520 PLEASANT VALLEY WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2802
Practice Address - Country:US
Practice Address - Phone:973-669-5711
Practice Address - Fax:973-669-5722
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA06872207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7427382OtherAETNA
P2733240OtherOXFORD
5000988003OtherCIGNA
2K8170OtherPHS
7427382OtherAETNA
2K8170OtherPHS