Provider Demographics
NPI:1700823937
Name:WALLENSTEIN, LISA BARBARA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:BARBARA
Last Name:WALLENSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:210 SUNRISE LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3934
Mailing Address - Country:US
Mailing Address - Phone:215-242-1649
Mailing Address - Fax:215-242-8348
Practice Address - Street 1:210 SUNRISE LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3934
Practice Address - Country:US
Practice Address - Phone:215-242-1649
Practice Address - Fax:215-242-8348
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD024754E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine