Provider Demographics
NPI:1629349774
Name:AXELROD, NORMAN MORTON (DO)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:MORTON
Last Name:AXELROD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 DEER FORD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5642
Mailing Address - Country:US
Mailing Address - Phone:717-393-6166
Mailing Address - Fax:
Practice Address - Street 1:52 DEER FORD DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5642
Practice Address - Country:US
Practice Address - Phone:717-393-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS001153L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery