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General NPI Number Information
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NPI Number | 1942025697
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Entity Type | Individual
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Provider Name | LALITA CATHERINE FORD PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 120 W MARTIN LUTHER KING JR DR
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City | WASHINGTON
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State | NC
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Zip | 27889-4906
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Country | US
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Telephone | 252-940-0602
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Fax |
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Provider Business Mailing Address
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Address Line | 4922 OLD PAGE RD APT 321
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City | DURHAM
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State | NC
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Zip | 27703-8096
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Country | US
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Telephone | 260-348-6304
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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