Individual provider · Type 1 NPI
Pearl A. Lake
Military Health Care Provider · Philadelphia, PA
NPI number
1053907261
Active
Practice location
2214 S 57th St
Philadelphia, PA 19143-5705
Fax (215) 825-5161
Mailing address
2250 E Monmouth St
Philadelphia, PA 19134-4103
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Military Health Care Provider | 171000000X | 70000634RMA (PA) |
| Military Health Care Provider Primary | 171000000X | 7000.000000634RMA (PA) |
Military Health Care Provider: Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
Another provider at this address
Other military health care provider providers in Philadelphia
About NPI 1053907261
Pearl A. Lake's National Provider Identifier is 1053907261, issued on Dec 12, 2020. The primary taxonomy on file is Military Health Care Provider (171000000X), and the practice location is in Philadelphia, PA. The record was last updated on Dec 12, 2020.