Healthcare Provider Details

I. General information

NPI: 1366114449
Provider Name (Legal Business Name): LAUREN ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W RUDDLE ST
COALDALE PA
18218-1027
US

IV. Provider business mailing address

504 DELTA RD
NORTHAMPTON PA
18067-2105
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-6643
  • Fax:
Mailing address:
  • Phone: 484-274-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: