Basic Information
| Provider Information | |||||||||
| NPI: | 1598051716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAM | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74 W BROAD ST STE 170 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180185738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845261260 | ||||||||
| FaxNumber: | 8338167511 | ||||||||
| Practice Location | |||||||||
| Address1: | 74 W BROAD ST STE 170 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180185738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845261260 | ||||||||
| FaxNumber: | 8338167511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2011 | ||||||||
| LastUpdateDate: | 07/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | MD470830 | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.