Provider Demographics
NPI:1922051770
Name:OSWALD, LORI BETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BETH
Last Name:OSWALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 RCA CENTER DR STE 2010
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4277
Mailing Address - Country:US
Mailing Address - Phone:561-881-8800
Mailing Address - Fax:561-848-5878
Practice Address - Street 1:11020 RCA CENTER DR STE 2010
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4277
Practice Address - Country:US
Practice Address - Phone:561-881-8800
Practice Address - Fax:561-848-5878
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002121363AM0700X
FLPA9105268363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR66464Medicare UPIN
MIE66013093Medicare ID - Type Unspecified