Provider Demographics
NPI:1972782878
Name:LAFAYETTE, TAMEKA PHEON (MD)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:PHEON
Last Name:LAFAYETTE
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 1:9430 BARCLAY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012
Mailing Address - Country:US
Mailing Address - Phone:215-599-4851
Mailing Address - Fax:
Practice Address - Street 1:361 ALEXANDER SPRING RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-6940
Practice Address - Country:US
Practice Address - Phone:717-960-1688
Practice Address - Fax:717-960-2208
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432696207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102164220Medicaid