Provider Demographics
NPI:1548651177
Name:AMMERMAN, LAUREN ROSE (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ROSE
Last Name:AMMERMAN
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 1:1101 MARKET ST
Mailing Address - Street 2:FL 30
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2934
Mailing Address - Country:US
Mailing Address - Phone:215-503-3685
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:LANE 154
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5133
Practice Address - Country:US
Practice Address - Phone:650-723-6661
Practice Address - Fax:650-498-6205
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD475646207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program