Individual
DR. ERIC J LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
525 W CHESTER PIKE, SUITE 203, HAVERTOWN, PA 19083-4500
(610) 789-7767
(610) 789-7768
Mailing address
525 W CHESTER PIKE, SUITE 203, HAVERTOWN, PA 19083-4500
(610) 789-7767
(610) 789-7768
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
OS012275
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016353100001
—
PA
Enumeration date
07/07/2006
Last updated
07/18/2012
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