Provider Demographics
NPI:1578840922
Name:MOORE, LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1454
Mailing Address - Country:US
Mailing Address - Phone:484-526-6545
Mailing Address - Fax:267-985-5001
Practice Address - Street 1:1107 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1454
Practice Address - Country:US
Practice Address - Phone:484-526-6545
Practice Address - Fax:267-985-5001
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055225363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant