Individual
DR. JONATHAN IAN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3400 SPRUCE ST, 100 CENTREX, PHILADELPHIA, PA 19104-4238
(215) 662-2200
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 662-2200
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD472772
PA
Other
Enumeration date
04/01/2015
Last updated
03/10/2022
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