1194132753 NPI number — DR. GLORIA DELORES LAMB DR OF PHILOSAPHY

Table of content: DR. GLORIA DELORES LAMB DR OF PHILOSAPHY (NPI 1194132753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194132753 NPI number — DR. GLORIA DELORES LAMB DR OF PHILOSAPHY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMB
Provider First Name:
GLORIA
Provider Middle Name:
DELORES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DR OF PHILOSAPHY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAMB
Provider Other First Name:
GLORIA
Provider Other Middle Name:
DELORES
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194132753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1545 CROSSWAYS BLVD
Provider Second Line Business Mailing Address:
SUITE 265
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-777-3955
Provider Business Mailing Address Fax Number:
751-777-3955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1545 CROSSWAYS BLVD
Provider Second Line Business Practice Location Address:
SUITE 265
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-777-3955
Provider Business Practice Location Address Fax Number:
751-777-3955
Provider Enumeration Date:
07/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  BUS:05896 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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