Provider Demographics
NPI:1346207636
Name:LAKATOS, KELLEY ELAINE (PAC)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:ELAINE
Last Name:LAKATOS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OSTRUM STREET
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:610-954-4000
Mailing Address - Fax:
Practice Address - Street 1:709 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1107
Practice Address - Country:US
Practice Address - Phone:610-954-3890
Practice Address - Fax:610-954-3046
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051966363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q41957Medicare UPIN