Provider Demographics
NPI:1093866188
Name:LAMP, MARLENE KAY (MD)
Entity type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:KAY
Last Name:LAMP
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 1:106 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3932
Mailing Address - Country:US
Mailing Address - Phone:805-660-0088
Mailing Address - Fax:
Practice Address - Street 1:106 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3932
Practice Address - Country:US
Practice Address - Phone:805-660-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG054126208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice