Provider Demographics
NPI:1790765782
Name:CHADWICK, LISA T (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:T
Last Name:CHADWICK
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 1:100 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478-1650
Mailing Address - Country:US
Mailing Address - Phone:724-569-8100
Mailing Address - Fax:724-569-8368
Practice Address - Street 1:100 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-1650
Practice Address - Country:US
Practice Address - Phone:724-569-8100
Practice Address - Fax:724-569-8368
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13571Medicare UPIN
082108Medicare ID - Type Unspecified