Provider Demographics
NPI:1639144835
Name:D'AMATO, LISA MARIE (PA - C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:D'AMATO
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2547
Mailing Address - Country:US
Mailing Address - Phone:610-363-0100
Mailing Address - Fax:610-363-3923
Practice Address - Street 1:750 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2547
Practice Address - Country:US
Practice Address - Phone:610-363-0100
Practice Address - Fax:610-363-3923
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002076363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOA002076OtherLICENSE NUMBER
PAQ62514Medicare UPIN
PA097811PT0Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID#