Provider Demographics
NPI:1922181262
Name:KING, LORRAINE CAROLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:CAROLE
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12140 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:STONE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08247-1057
Mailing Address - Country:US
Mailing Address - Phone:609-368-7618
Mailing Address - Fax:
Practice Address - Street 1:12140 2ND AVE
Practice Address - Street 2:
Practice Address - City:STONE HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08247-1057
Practice Address - Country:US
Practice Address - Phone:609-368-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013434E207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC32194Medicare UPIN