Provider Demographics
NPI:1164659009
Name:BANGOR, LAUREN MELO (DO)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MELO
Last Name:BANGOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3505
Mailing Address - Country:US
Mailing Address - Phone:215-503-7300
Mailing Address - Fax:215-503-5666
Practice Address - Street 1:700 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3505
Practice Address - Country:US
Practice Address - Phone:215-503-7300
Practice Address - Fax:215-503-5666
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013139207P00000X
SCTL1661207P00000X
PAOS017040207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine