MEDICARE: LORENZO TARPLEY JR. PA-C

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	363AM0700X	Medical Physician Assistant	14666	CA
2	363AM0700X	Medical Physician Assistant		IL

General Provider Information

NPI Number	:	1235130543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORENZO TARPLEY JR. PA-C

Provider Business Mailing Address
First Line	:	30 ROLLINGSIDE DR
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22406-7268
Country	:	US
Telephone Number	:	540-752-9517
Fax Number	:	540-752-9589

Provider Business Practice Location Address
First Line	:	2300 E STREET NW
Second Line	:	BUREAU OF MEDICINE AND SURGERY
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5300
Country	:	US
Telephone Number	:	202-762-0174
Fax Number	:	202-762-3470

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/13/2007

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