Provider Demographics
NPI:1992460547
Name:LAMB, NICHOLAS LOUIS (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LOUIS
Last Name:LAMB
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-3406
Mailing Address - Country:US
Mailing Address - Phone:215-275-3558
Mailing Address - Fax:
Practice Address - Street 1:438 GANTTOWN RD STE B8-B9
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2341
Practice Address - Country:US
Practice Address - Phone:856-344-7916
Practice Address - Fax:856-344-7920
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00660500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant