Provider Demographics
NPI:1558303826
Name:PICHNEY, LISA SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SUSAN
Last Name:PICHNEY
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 1:7505 OSLER DR
Mailing Address - Street 2:SUITE #309
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7736
Mailing Address - Country:US
Mailing Address - Phone:410-769-9300
Mailing Address - Fax:410-769-9301
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:SUITE #309
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-769-9300
Practice Address - Fax:410-769-9301
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037183207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD058981100Medicaid
MD058981100Medicaid
MDE45593Medicare UPIN