Provider Demographics
NPI:1740440031
Name:ELLIOTT, LAUREN M (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:BELCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1412 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2908
Mailing Address - Country:US
Mailing Address - Phone:215-599-4851
Mailing Address - Fax:215-232-4093
Practice Address - Street 1:841 E HUNTING PARK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-4800
Practice Address - Country:US
Practice Address - Phone:215-537-7695
Practice Address - Fax:215-537-7001
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant