Provider Demographics
NPI:1003805839
Name:HUTTON, LISA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:HUTTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1047 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-4617
Mailing Address - Country:US
Mailing Address - Phone:215-886-1240
Mailing Address - Fax:215-886-7591
Practice Address - Street 1:1047 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-4617
Practice Address - Country:US
Practice Address - Phone:215-886-1240
Practice Address - Fax:215-886-7591
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA042309-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE79554Medicare UPIN