Provider Demographics
NPI:1760676282
Name:LISA S. PICHNEY, MD, PA
Entity Type:Organization
Organization Name:LISA S. PICHNEY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PICHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-769-9300
Mailing Address - Street 1:7505 OSLER DR
Mailing Address - Street 2:SUITE #309
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7736
Mailing Address - Country:US
Mailing Address - Phone:410-769-9300
Mailing Address - Fax:410-769-9301
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:SUITE #309
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-769-9300
Practice Address - Fax:410-769-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37183207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE45593Medicare UPIN
MD623MMedicare PIN