Provider Demographics
NPI:1891089033
Name:SOMMER, LACY L (MD)
Entity type:Individual
Prefix:DR
First Name:LACY
Middle Name:L
Last Name:SOMMER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SAGEMORE DR STE 10101
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3944
Mailing Address - Country:US
Mailing Address - Phone:856-596-0111
Mailing Address - Fax:568-596-7194
Practice Address - Street 1:10000 SAGEMORE DR STE 10101
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3944
Practice Address - Country:US
Practice Address - Phone:856-596-0111
Practice Address - Fax:856-596-7194
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT199328207R00000X
NJ25MA09368200207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine