Provider Demographics
NPI:1750300240
Name:MASLANKOWSKI, LISA A (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MASLANKOWSKI
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 1:321 W GIRARD AVE
Mailing Address - Street 2:HEALTH CENTER #6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1531
Mailing Address - Country:US
Mailing Address - Phone:215-685-3808
Mailing Address - Fax:215-685-3852
Practice Address - Street 1:321 W GIRARD AVE
Practice Address - Street 2:HEALTH CENTER #6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1531
Practice Address - Country:US
Practice Address - Phone:215-685-3808
Practice Address - Fax:215-685-3852
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056822L2084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG12258Medicare UPIN
PAG12258Medicare UPIN