Provider Demographics
NPI:1770511826
Name:PINHEIRO, LISA WINER (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:WINER
Last Name:PINHEIRO
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 1:250 KING OF PRUSSIA RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5235
Mailing Address - Country:US
Mailing Address - Phone:610-341-9812
Mailing Address - Fax:
Practice Address - Street 1:701 E MARSHALL STREET
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380
Practice Address - Country:US
Practice Address - Phone:610-431-5131
Practice Address - Fax:215-945-6809
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068849L2085R0202X
NJ25MA088616002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017585220001Medicaid
PA0017585220001Medicaid
PA027997Medicare PIN