Healthcare Provider Details

I. General information

NPI: 1356336960
Provider Name (Legal Business Name): KATHLEEN GRAHAM LOMAX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTH PLZ BUILDING 125/3434A
EAST HANOVER NJ
07936-1016
US

IV. Provider business mailing address

1 HEALTH PLZ BUILDING 125/3434A
EAST HANOVER NJ
07936-1016
US

V. Phone/Fax

Practice location:
  • Phone: 862-778-7643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number25MA07481300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: