Provider Demographics
NPI:1366525198
Name:JARVIS, LORI J (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:JARVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 FRANKLIN CORNER RD
Mailing Address - Street 2:MOSAIC HEALTH
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2586
Mailing Address - Country:US
Mailing Address - Phone:609-482-3701
Mailing Address - Fax:609-482-3702
Practice Address - Street 1:136 FRANKLIN CORNER RD
Practice Address - Street 2:MOSAIC HEALTH
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2586
Practice Address - Country:US
Practice Address - Phone:609-482-3701
Practice Address - Fax:609-482-3702
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06108900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G30419Medicare UPIN
879970NPAMedicare ID - Type Unspecified