Provider Demographics
NPI:1629061601
Name:WALLOWER, LORI LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LEE
Last Name:WALLOWER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4093
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:126 W CHURCH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-1280
Practice Address - Country:US
Practice Address - Phone:717-432-2411
Practice Address - Fax:717-432-1409
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006988L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA611895Medicare UPIN
PAE92039Medicare UPIN