Provider Demographics
NPI:1013930023
Name:TALBOT, LORI C (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:C
Last Name:TALBOT
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 1:215 BACK NECK RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-6834
Mailing Address - Country:US
Mailing Address - Phone:856-451-4414
Mailing Address - Fax:856-451-2052
Practice Address - Street 1:215 BACK NECK ROAD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302
Practice Address - Country:US
Practice Address - Phone:856-451-4414
Practice Address - Fax:856-451-2052
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO5305000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3615405Medicaid
E52131Medicare UPIN
NJ3615405Medicaid