Individual
DR. LARRY L LODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
200 ROUTE 73 STE 3, VOORHEES, NJ 08043-9542
(856) 753-1300
(856) 768-2965
Mailing address
200 B ROUTE 73, SUITE 3, GARDEN STATE FOOT CARE, VOORHEES, NJ 08043-9542
(856) 753-1300
(856) 768-2965
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD002054
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
538006
—
NJ
Enumeration date
08/25/2005
Last updated
02/25/2010
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