Provider Demographics
NPI:1275588691
Name:ROUSCHE, LORI E (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:E
Last Name:ROUSCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 ROUTE 113
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1000
Mailing Address - Country:US
Mailing Address - Phone:215-723-3280
Mailing Address - Fax:
Practice Address - Street 1:777 ROUTE 113
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1000
Practice Address - Country:US
Practice Address - Phone:215-723-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042355L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE99347Medicare UPIN