Basic Information
| Provider Information | |||||||||
| NPI: | 1316359482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUKARZEL | ||||||||
| FirstName: | LEA | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3941 COMMERCE AVE # 279 | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1524814085 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3941 COMMERCE AVE | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154814000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2014 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4410 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | MD477353 | PA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.