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General NPI Number Information
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NPI Number | 1497448724
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Entity Type | Organization
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Legal Business Name | LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE, INC.
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 5515 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509-2603
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Country | US
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Telephone | 814-868-8258
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 W GRANDVIEW BLVD
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City | ERIE
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State | PA
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Zip | 16509-1029
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Country | US
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Telephone | 814-868-1030
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Fax |
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Authorized Official
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Title or Position | VP FISCAL AFFAIRS/CFO
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Name | STEVEN GREGORY INMAN
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Credential |
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Telephone | 814-868-8258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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