Provider Demographics
NPI:1194816777
Name:HAMILTON, LISA H (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:H
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:3855 W CHESTER PIKE STE 245
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2304
Mailing Address - Country:US
Mailing Address - Phone:610-325-3880
Mailing Address - Fax:610-325-3887
Practice Address - Street 1:3855 W CHESTER PIKE STE 245
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073
Practice Address - Country:US
Practice Address - Phone:610-325-3880
Practice Address - Fax:610-325-3887
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003377L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA220259YEXCOtherMEDICARE PTAN