Provider Demographics
NPI:1437417342
Name:VAN TASSEL, LORA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:J
Last Name:VAN TASSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:J
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3145 E CHANDLER BLVD STE 110-109
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8702
Mailing Address - Country:US
Mailing Address - Phone:602-935-9773
Mailing Address - Fax:
Practice Address - Street 1:3145 E CHANDLER BLVD STE 110-109
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8702
Practice Address - Country:US
Practice Address - Phone:602-935-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50424208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics