Provider Demographics
NPI:1699030874
Name:CASTENOVA, LISA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:CASTENOVA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:5800 RIDGE AVENUE
Mailing Address - Street 2:ROXBOROUGH MEMORIAL HOSPITAL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128
Mailing Address - Country:US
Mailing Address - Phone:215-487-4312
Mailing Address - Fax:215-487-4689
Practice Address - Street 1:5800 RIDGE AVENUE
Practice Address - Street 2:ROXBOROUGH MEMORIAL HOSPITAL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128
Practice Address - Country:US
Practice Address - Phone:215-487-4312
Practice Address - Fax:215-487-4689
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001570L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA183791YMEMMedicare PIN