MEDICARE: LOREN ODAM MD

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	207Q00000X	Family Medicine Physician	MT236418	PA

General Provider Information

NPI Number	:	1508793803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOREN ODAM MD

Provider Business Mailing Address
First Line	:	10 SHURS LN STE 203
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 SHURS LN STE 203
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2123
Country	:	US
Telephone Number	:	215-482-1234
Fax Number	:

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

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/11/2026

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Directions to “ LOREN ODAM MD” Practice Location

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