Lodge, Larry L
Lodge, Larry L is an sole proprietor health care provider with primary practice located at 200 Route 73 Ste 3 , Voorhees NJ 08043-9542. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Lodge, Larry L can be contacted via phone (856) 753-1300.Contact Information
Primary practice address
200 Route 73 Ste 3
Voorhees NJ 08043-9542
Phone: (856) 753-1300
Fax: (856) 768-2965
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | 25MD002054 | New Jersey |
Profile Details
| NPI number | 1497748354 |
|---|---|
| LBN Legal business name | Lodge, Larry L |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 25th, 2005 |
| Last updated | Feb 25th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497748354 | NPPES |
| New Jersey | MEDICAID | 538006 |
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