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General NPI Number Information
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NPI Number | 1699038349
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Entity Type | Individual
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Provider Name | GLORIA FONTANE LAM D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 18 E LAUREL RD
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City | STRATFORD
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State | NJ
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Zip | 08084-1327
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Country | US
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Telephone | 856-218-5634
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Fax | 856-218-5664
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Provider Business Mailing Address
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Address Line | 151 FRIES MILL RD STE 301
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-2016
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Country | US
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Telephone | 856-513-4124
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Fax | 856-302-5932
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 25MB09641100
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License Number State | NJ
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