Healthcare Provider Details

I. General information

NPI: 1700397296
Provider Name (Legal Business Name): ALEXANDRA LAHURD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 ROUTE 70 SUITE C
MARLTON NJ
08053
US

IV. Provider business mailing address

301 LIPPINCOTT DR
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-355-7176
  • Fax: 856-983-1006
Mailing address:
  • Phone: 856-355-0335
  • Fax: 856-355-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: