Individual
LORI MARIE PROCTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
3885 MECHANICSVILLE RD, WHITEHALL, PA 18052-3321
(610) 437-9343
(610) 437-5997
Mailing address
3885 MECHANICSVILLE RD, WHITEHALL, PA 18052-3321
(610) 437-9343
(610) 437-5997
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC003287L
PA
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001133549
—
PA
01
—
122132
THREE RIVERS
PA
01
—
1519638
GATEWAY
PA
01
—
1810101
CAPITOL BLUE CROSS
PA
01
—
428757
MEDICARE PTAN
PA
Enumeration date
11/22/2005
Last updated
08/10/2011
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