1316983984 NPI number — DEE ANN S LISBY MD

Table of content: DEE ANN S LISBY MD (NPI 1316983984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316983984 NPI number — DEE ANN S LISBY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LISBY
Provider First Name:
DEE ANN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316983984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N 20TH ST
Provider Second Line Business Mailing Address:
CHOP SUITE 301
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19103-1443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-567-2422
Provider Business Mailing Address Fax Number:
215-561-0959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34TH & CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF PHILADELPHIA
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-1000
Provider Business Practice Location Address Fax Number:
215-561-0959
Provider Enumeration Date:
06/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD052992L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080N0001X , with the licence number: MD052992L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7269706 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016390020001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".