=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003550708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN I KASOFF
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2022
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 E LANCASTER AVE STE 300
-----------------------------------------------------
City | WYNNEWOOD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19096-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-617-1300
-----------------------------------------------------
Fax | 610-617-0199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3803 W CHESTER PIKE STE 160
-----------------------------------------------------
City | NEWTOWN SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19073-2336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-337-1632
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD488719
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------