Provider Demographics
NPI:1366658478
Name:LOHMAN, MICHELE LYNNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LYNNE
Last Name:LOHMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LYNNE
Other - Last Name:DEOLIVEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 4059
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4059
Mailing Address - Country:US
Mailing Address - Phone:973-826-1540
Mailing Address - Fax:855-834-5435
Practice Address - Street 1:145 US HIGHWAY 46
Practice Address - Street 2:SUITE 304
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6830
Practice Address - Country:US
Practice Address - Phone:973-826-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00148300363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ275284OtherGRP PTAN QUALITY SURGICAL SERVICES LLC
NJ329343YP69Medicare PIN
NJ275284OtherGRP PTAN QUALITY SURGICAL SERVICES LLC