Provider Demographics
NPI:1780733667
Name:LOTT, KRISTEN E (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:LOTT
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 1:100 CARNIE BLVD
Mailing Address - Street 2:SUITE B5
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4512
Mailing Address - Country:US
Mailing Address - Phone:856-751-0123
Mailing Address - Fax:856-751-0535
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE B5
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-0535
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1859582085R0202X
PAMD4364182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102287515-0001Medicaid
PA151374D2YMedicare PIN