Basic Information
| Provider Information | |||||||||
| NPI: | 1972782878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAFAYETTE | ||||||||
| FirstName: | TAMEKA | ||||||||
| MiddleName: | PHEON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9430 BARCLAY ROAD | ||||||||
| Address2: | |||||||||
| City: | CHELTENHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155994851 | ||||||||
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| Practice Location | |||||||||
| Address1: | 361 ALEXANDER SPRING RD | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170156940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179601688 | ||||||||
| FaxNumber: | 7179602208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2007 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD432696 | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 102164220 | 05 | PA | MEDICAID |