Pearl A Lake
Military Health Care Provider in Philadelphia, PA. Individual provider (NPI-1).
NPI number1053907261
StatusActive
Last updated in NPPESDec 12, 2020
Details
- NPI
- 1053907261
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Pearl A Lake
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Dec 12, 2020
- Certification date
- Dec 12, 2020
- Last updated
- Dec 12, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171000000X | Military Health Care Provider | 7000.000000634RMA | PA | Yes |
| 171000000X | Military Health Care Provider | 70000634RMA | PA |
Practice location
2214 S 57th StPhiladelphia, PA 19143-5705
Phone 886-884-8807 · Fax 215-825-5161
Mailing address
2250 E Monmouth StPhiladelphia, PA 19134-4103
Phone 267-884-8807 · Fax 215-825-5161
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 5 Military Health Care Provider providers in Philadelphia · All 53,595 providers in Philadelphia
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