Healthcare Provider Details

I. General information

NPI: 1073171708
Provider Name (Legal Business Name): LAUREN MCCRILLIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 HAMILTON BLVD
TREXLERTOWN PA
18087-9101
US

IV. Provider business mailing address

3039 MAGNOLIA CIR
MACUNGIE PA
18062-9351
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-2600
  • Fax:
Mailing address:
  • Phone: 724-977-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOT01900
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS022258
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: