Healthcare Provider Details

I. General information

NPI: 1912964446
Provider Name (Legal Business Name): LORI E LARUE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N BANCROFT PKWY SUITE 12
WILMINGTON DE
19805-2690
US

IV. Provider business mailing address

1010 N BANCROFT PKWY SUITE 12
WILMINGTON DE
19805-2690
US

V. Phone/Fax

Practice location:
  • Phone: 302-658-1129
  • Fax: 302-658-7646
Mailing address:
  • Phone: 302-658-1129
  • Fax: 302-658-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1-0000088
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: