Provider Demographics
NPI:1073514923
Name:NATH, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:NATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:511 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3507
Mailing Address - Country:US
Mailing Address - Phone:412-734-5022
Mailing Address - Fax:412-766-1316
Practice Address - Street 1:511 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3550
Practice Address - Country:US
Practice Address - Phone:412-734-5022
Practice Address - Fax:412-766-1316
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD062104L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016491610008Medicaid
PA001409074OtherHIGHMARK BC/BS
PAG47441Medicare UPIN
PA001409074OtherHIGHMARK BC/BS