Provider Demographics
NPI:1194738203
Name:DEPASS, LORRAINE FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:FRANCIS
Last Name:DEPASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:80 N GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2425
Mailing Address - Country:US
Mailing Address - Phone:908-218-1121
Mailing Address - Fax:908-253-9031
Practice Address - Street 1:80 N GASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2425
Practice Address - Country:US
Practice Address - Phone:908-218-1121
Practice Address - Fax:908-253-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA65356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG74322Medicare UPIN
NJ091285Medicare ID - Type Unspecified