LANCELOT K TIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036069653

License Status

NOT RENEWED

Business

First Name

LANCELOT K

Last Name

TIN

Suffix

Business Name

LANCELOT K TIN MD

Original Issue Date

10/17/1984

Effective Date

10/17/1984

Expiration Date

07/31/1987

City

PHILADELPHIA

State

Zip

19107

County

PENNSYLVANIA

Ever Disciplined

LastModifiedDate

09/20/2006