Provider Demographics
NPI:1639139975
Name:EAKIN, LORI O (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:O
Last Name:EAKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ALISON
Other - Last Name:OETTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:22 ST PAUL DR STE 207
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1033
Practice Address - Country:US
Practice Address - Phone:717-709-6599
Practice Address - Fax:717-217-6002
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60239419208600000X
PAMD028139E2086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001048878 0010Medicaid
PA001048878Medicaid
PA175391Medicare ID - Type Unspecified
B40700Medicare UPIN