Provider Demographics
NPI:1093998130
Name:KALLENBACH, LISA R (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:KALLENBACH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2 INDUSTRIAL BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1645
Mailing Address - Country:US
Mailing Address - Phone:610-725-0650
Mailing Address - Fax:610-725-9583
Practice Address - Street 1:2 INDUSTRIAL BLVD
Practice Address - Street 2:STE 110
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1645
Practice Address - Country:US
Practice Address - Phone:610-725-0650
Practice Address - Fax:610-725-9583
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2014-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD438408207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA179046NXHMedicare PIN