Provider Demographics
NPI:1538208681
Name:FISHKIN, LANA PRINCE (MD)
Entity type:Individual
Prefix:DR
First Name:LANA
Middle Name:PRINCE
Last Name:FISHKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 GRAMERCY RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2904
Mailing Address - Country:US
Mailing Address - Phone:610-667-3789
Mailing Address - Fax:610-667-3789
Practice Address - Street 1:171 GRAMERCY RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2904
Practice Address - Country:US
Practice Address - Phone:610-667-3789
Practice Address - Fax:610-667-3789
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012858E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE63986Medicare UPIN
PAFI170908Medicare ID - Type Unspecified