Basic Information
Provider Information
NPI: 1194178004
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMBERT
FirstName: PETER
MiddleName: CLARK
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1500 LANSDOWNE AVE # 610-23
Address2:  
City: DARBY
State: PA
PostalCode: 190231200
CountryCode: US
TelephoneNumber: 6102374000
FaxNumber:  
Practice Location
Address1: 1500 LANSDOWNE AVE # 610-23
Address2:  
City: DARBY
State: PA
PostalCode: 190231200
CountryCode: US
TelephoneNumber: 6102374000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/14/2016
LastUpdateDate: 06/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMT211898PAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RE0101X35144OKY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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