Provider Demographics
NPI:1861408098
Name:LISHANSKY, IZOLDA (MD)
Entity type:Individual
Prefix:
First Name:IZOLDA
Middle Name:
Last Name:LISHANSKY
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:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-677-1475
Mailing Address - Fax:215-677-3082
Practice Address - Street 1:2301 E ALLEGHENY AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:215-677-1475
Practice Address - Fax:215-677-3082
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD37461E207P00000X
PAMD037461E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011979300001Medicaid
PACD4829OtherTPI RAILROAD MEDICARE GROUP
PA1007278000OtherTPI MEDICAID GROUP
PA597586OtherTPI MEDICARE GROUP
E52973Medicare UPIN
PA1007278000OtherTPI MEDICAID GROUP