MEDICARE: DR. LORI A REAVES DO

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	MBO64192	NJ

General Provider Information

NPI Number	:	1417959503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI A REAVES DO

Provider Business Mailing Address
First Line	:	640 NORTH WHITE HORSE PIKE
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037
Country	:	US
Telephone Number	:	609-567-9003
Fax Number	:	858-373-2478

Provider Business Practice Location Address
First Line	:	640 NORTH WHITE HORSE PIKE
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037
Country	:	US
Telephone Number	:	609-567-9003
Fax Number	:	609-567-9269

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	11/19/2009

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