Healthcare Provider Details

I. General information

NPI: 1245267350
Provider Name (Legal Business Name): DAVID MORRIS LAMPORT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/15/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 COLUMBUS RD
FREDERICKTOWN OH
43019-1266
US

IV. Provider business mailing address

122 COLUMBUS RD
FREDERICKTOWN OH
43019-1266
US

V. Phone/Fax

Practice location:
  • Phone: 740-694-1261
  • Fax: 740-694-7145
Mailing address:
  • Phone: 740-694-1261
  • Fax: 740-694-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.001091RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: