Provider Demographics
NPI:1801839311
Name:THARP, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:THARP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 FREDRICKSTOWN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDLAND
Mailing Address - State:PA
Mailing Address - Zip Code:15059-2204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2261
Practice Address - Country:US
Practice Address - Phone:724-774-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000976-L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA000976-LOtherLICENSE
092773FHTMedicare ID - Type Unspecified