Provider Demographics
NPI:1790233237
Name:LAKEVIEW ORTHOPEDIC ASSOCIATES PC
Entity Type:Organization
Organization Name:LAKEVIEW ORTHOPEDIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-462-4877
Mailing Address - Street 1:550 PINETOWN ROAD
Mailing Address - Street 2:SUITE 250 2ND FLOOR
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2613
Mailing Address - Country:US
Mailing Address - Phone:267-462-4877
Mailing Address - Fax:267-462-4878
Practice Address - Street 1:550 PINETOWN ROAD
Practice Address - Street 2:SUITE 250 2ND FLOOR
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2613
Practice Address - Country:US
Practice Address - Phone:267-462-4877
Practice Address - Fax:267-462-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016741E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty