Provider Demographics
NPI:1770674566
Name:LAM, STEPHANIE K (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:LAM
Suffix:
Gender:F
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:PO BOX 95000-2428
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2428
Mailing Address - Country:US
Mailing Address - Phone:212-879-4742
Mailing Address - Fax:212-288-2126
Practice Address - Street 1:16TH STREET AT 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-477-1325
Practice Address - Fax:212-505-6346
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228189207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99768Medicare UPIN
NY715091Medicare ID - Type Unspecified