Basic Information
Provider Information
NPI: 1063826972
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LABUZ
FirstName: MEGAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3435 WINCHESTER RD
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181042268
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber:  
Practice Location
Address1: 1503 N CEDAR CREST BLVD
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 18104
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2014
LastUpdateDate: 11/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QS0010XMD465845PAY Allopathic & Osteopathic PhysiciansFamily MedicineSports Medicine

No ID Information.


Home