Healthcare Provider Details

I. General information

NPI: 1629573985
Provider Name (Legal Business Name): MARY CATHERINE LARE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 EMRICK BLVD STE 112
BETHLEHEM PA
18020-8037
US

IV. Provider business mailing address

3101 EMRICK BLVD STE 112
BETHLEHEM PA
18020-8037
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5570
  • Fax: 833-932-1227
Mailing address:
  • Phone: 484-822-5570
  • Fax: 833-932-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS023385
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB11132500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: