Provider Demographics
NPI:1740202217
Name:GOSS, LISA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:GOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:ALLENBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95 LEONARD AVE
Mailing Address - Street 2:BLDG 2
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3368
Mailing Address - Country:US
Mailing Address - Phone:724-223-3100
Mailing Address - Fax:724-223-3353
Practice Address - Street 1:67 E PIKE ST
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-1311
Practice Address - Country:US
Practice Address - Phone:724-745-4100
Practice Address - Fax:724-746-9880
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071791L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00911363OtherHIGHMARK
306179OtherUNISON
213137OtherUPMC
PA0018196550009Medicaid
PAH25684Medicare UPIN
306179OtherUNISON