=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154743565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LORI PEPPERS, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2014
-----------------------------------------------------
Last Update Date | 01/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 892 E BRIGHTON AVE SUITE 3
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13205-2542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-849-3934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 892 E BRIGHTON AVE SUITE 3
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13205-2542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-849-3934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LORI PEPPERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-849-3934
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 2968961
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------