Provider Demographics
NPI:1396192480
Name:LACOVARA, MEGHAN (MD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:LACOVARA
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 1:200 TRENTON ROAD
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015
Mailing Address - Country:US
Mailing Address - Phone:609-893-6611
Mailing Address - Fax:
Practice Address - Street 1:200 TRENTON ROAD
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015
Practice Address - Country:US
Practice Address - Phone:609-893-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10632600208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist