Provider Demographics
NPI:1740282177
Name:RADFAR-BAUBLITZ, LALEH SARAH (DO)
Entity type:Individual
Prefix:
First Name:LALEH
Middle Name:SARAH
Last Name:RADFAR-BAUBLITZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LALEH
Other - Middle Name:SARAH
Other - Last Name:RADFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:233 COLLEGE AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3384
Mailing Address - Country:US
Mailing Address - Phone:717-358-0800
Mailing Address - Fax:717-358-0803
Practice Address - Street 1:233 COLLEGE AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3384
Practice Address - Country:US
Practice Address - Phone:717-358-0800
Practice Address - Fax:717-358-0803
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010841L2081P2900X
PAOS-010841L208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I01391Medicare UPIN