MEDICARE: LORELL UPCHURCH

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	246RP1900X	Phlebotomy Technician		PA

General Provider Information

NPI Number	:	1245090976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORELL UPCHURCH

Provider Business Mailing Address
First Line	:	331 E CLAREMONT RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-1015
Country	:	US
Telephone Number	:	267-242-2921
Fax Number	:

Provider Business Practice Location Address
First Line	:	7244 CASTOR AVE UNIT 8227
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1109
Country	:	US
Telephone Number	:	215-602-4857
Fax Number	:

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

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/20/2024

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Directions to “ LORELL UPCHURCH ” Practice Location

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