person
Mrs. Pearl A Lake
Military Health Care Provider in Philadelphia, Pennsylvania
NPI 1053907261

Pearl A Lake is a Military Health Care Provider based in Philadelphia, PA. Pearl A Lake practices in Philadelphia, PA. The NPI Number for Pearl A Lake is 1053907261 and holds a License No. 70000634RMA (Pennsylvania).

The current practice location address for Pearl A Lake is 2214 S 57Th St, Philadelphia, PA and can be reached out via phone at 886-884-8807 and via fax at 215-825-5161.

Location: 2214 S 57Th St, Philadelphia, PA, 19134-4103
person
Provider Profile Details
NPI Number
1053907261
Provider Name
Pearl A Lake
Credential
Provider Entity Type
Individual
Gender
Female
Address
2214 S 57Th St, Philadelphia, PA, 19134-4103
Phone Number
886-884-8807
Fax Number
215-825-5161
Provider Enumeration Date
12/12/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
2214 S 57Th St
City
State
Zip
19143-5705
Phone Number
886-884-8807
Fax Number
215-825-5161
person
Provider Business Mailing Address Details
Address
2214 S 57Th St
City
State
Zip
19143-5705
Phone Number
886-884-8807
Fax Number
215-825-5161
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
License No.
70000634RMA (Pennsylvania)
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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