Basic Information
| Provider Information | |||||||||
| NPI: | 1639139975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EAKIN | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OETTING | ||||||||
| OtherFirstName: | LORI | ||||||||
| OtherMiddleName: | ALISON | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 ST PAUL DR STE 207 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177096599 | ||||||||
| FaxNumber: | 7172176002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD60239419 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 2086X0206X | MD028139E | PA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 208600000X | MD028139E | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 001048878 0010 | 05 | PA | MEDICAID | 001048878 | 05 | PA | MEDICAID |