Healthcare Provider Details

I. General information

NPI: 1962759985
Provider Name (Legal Business Name): AMRITA LALVANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

301 S 11TH ST UNIT 602
PHILADELPHIA PA
19107-6056
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4963
  • Fax:
Mailing address:
  • Phone: 703-507-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD454734
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101267012
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: