Individual
LORENNA LOURHANCE MOREIRA VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 SPRUCE ST, PHILADELPHIA, PA 19107-6130
(215) 829-3201
(215) 829-5697
Mailing address
800 SPRUCE ST, PHILADELPHIA, PA 19107-6130
(215) 829-3201
(215) 829-5697
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
D83861
MD
2085R0202X
Diagnostic Radiology Physician
D83861
MD
2085R0202X
Diagnostic Radiology Physician
Primary
MD469966
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092582405
—
DC
05
—
583205500
—
MD
Enumeration date
06/13/2013
Last updated
11/03/2021
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