Provider Demographics
NPI:1891006508
Name:CONCODORA, LAUREN (DPM)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CONCODORA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 PACKER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-5407
Mailing Address - Country:US
Mailing Address - Phone:215-334-9900
Mailing Address - Fax:
Practice Address - Street 1:1546 PACKER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-5407
Practice Address - Country:US
Practice Address - Phone:215-334-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006208213ES0103X
DEE1-0000217213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery