Provider Demographics
NPI:1255353421
Name:BOARDMAN, LORI (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BOARDMAN
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 1:12201 RESEARCH PKWY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32816-0001
Mailing Address - Country:US
Mailing Address - Phone:407-823-0500
Mailing Address - Fax:407-823-1856
Practice Address - Street 1:12201 RESEARCH PKWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-0001
Practice Address - Country:US
Practice Address - Phone:407-823-0500
Practice Address - Fax:407-823-1856
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD8463207V00000X
FLME 102469207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBP115YMedicare PIN
FLBP115ZMedicare PIN