Provider Demographics
NPI:1235221821
Name:HWANG, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HWANG
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 1:105 BRAUNLICH DR
Mailing Address - Street 2:STE. 102
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3348
Mailing Address - Country:US
Mailing Address - Phone:412-369-7720
Mailing Address - Fax:412-369-7751
Practice Address - Street 1:105 BRAUNLICH DR
Practice Address - Street 2:STE. 102
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3348
Practice Address - Country:US
Practice Address - Phone:412-369-7720
Practice Address - Fax:412-369-7751
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058319L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015799510004Medicaid
PA0015799510004Medicaid