Lakeside Internal Medicine Associates,LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MB47569 Issued in NJ

Legal business name

LAKESIDE INTERNAL MEDICINE ASSOCIATES,LLC

Practice address

1300 Liberty PL
Sicklerville, NJ 08081-5710

Phone

(856) 374-5304

NPI assigned

Dec 30, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David A Evans, D.O.

Title

Owner

Phone

(856) 374-5304

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1230595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230595200000",
    "number": "1346486032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 LIBERTY PL",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080815710",
            "telephone_number": "856-374-5304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 LIBERTY PL",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080815710",
            "telephone_number": "856-374-5304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE INTERNAL MEDICINE ASSOCIATES,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-30",
        "last_updated": "2008-12-30",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-374-5304",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MB47569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Vincent Kracke, DMD
• Ashley Nicole Krumenacker, PHARMD
• Rochelle Theresa Kugler, RPH
• Lactation Goddess
• Angela Ladson
• Lakeside Recovery Center
• Elaine Gail Lange, R.N, A.P.N.
• Melissa Tabitha Laster
• Wisdom Afangide Lawal Sr.
• Andrea J Leach, LCSW

• Internal Medicine Physician in Sicklerville, NJ
• Providers in Sicklerville, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.