Provider Demographics
NPI:1902838147
Name:LISS, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:LISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2613
Mailing Address - Fax:717-798-3677
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2613
Practice Address - Fax:717-798-3677
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026620E208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30267OtherJOHNS HOPKINS
PA1142823OtherAMERIHEALTH MERCY-WMG
PA00963494Medicaid
PA341502OtherMAMSI-WMG
MD005624300Medicaid
PA1511720OtherGATEWAY-WMG
PA34202OtherGEISINGER
PA5577109OtherAETNA
MD543415OtherCAREFIRST MD BCBS
PA80858OtherUNISON-WMG
PA20101249OtherAMERIHEALTH MERCY-YHOBT
PA0069228000OtherAMERIHEALTH 65 PA
PA01821702OtherCAPITAL BLUE CROSS-WMG
PA438042OtherHIGHMARK BLUE SHIELD
PA34202OtherGEISINGER
MD543415OtherCAREFIRST MD BCBS
PA341502OtherMAMSI-WMG