MEDICARE: DR. ERIC LAGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	006433E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00560032000	OTHER	PA	BLUE CROSS

General Provider Information

NPI Number	:	1023170743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC LAGER M.D.

Provider Business Mailing Address
First Line	:	2400 CHESTNUT ST
Second Line	:	3302
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4316
Country	:	US
Telephone Number	:	215-665-1867
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 CHESTNUT ST
Second Line	:	3302
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4316
Country	:	US
Telephone Number	:	215-665-1867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	04/07/2008

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