Healthcare Provider Details

I. General information

NPI: 1063569820
Provider Name (Legal Business Name): LORI A WALTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 WELSH RD STE 201
HUNTINGDON VALLEY PA
19006-6311
US

IV. Provider business mailing address

2360 MARYLAND RD
WILLOW GROVE PA
19090-1709
US

V. Phone/Fax

Practice location:
  • Phone: 215-657-6776
  • Fax: 267-913-5961
Mailing address:
  • Phone: 215-657-6776
  • Fax: 267-913-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA001642L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: