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General NPI Number Information
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NPI Number | 1417035981
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Entity Type | Individual
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Provider Name | LORI ANN SPORTELLI OD
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 2657 N SALISBURY BLVD STE 104
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City | SALISBURY
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State | MD
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Zip | 21801-2184
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Country | US
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Telephone | 410-742-6148
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Fax | 410-219-3654
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Provider Business Mailing Address
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Address Line | 814 S ELLWOOD AVE
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City | BALTIMORE
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State | MD
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Zip | 21224-3951
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Country | US
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Telephone | 410-284-2352
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Fax | 410-284-3796
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA1569
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License Number State | MD
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