Basic Information
| Provider Information | |||||||||
| NPI: | 1598744740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAM | ||||||||
| FirstName: | LORIE | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4225 ALTAMONT PL | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206953063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406071500 | ||||||||
| FaxNumber: | 4103672215 | ||||||||
| Practice Location | |||||||||
| Address1: | 4225 ALTAMONT PL | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206953063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2406071500 | ||||||||
| FaxNumber: | 4103672215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2006 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K1994 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D76898 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 142218003 | 05 | TX | MEDICAID |