Provider Demographics
NPI:1831124171
Name:ZORN, LISA M (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:ZORN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:ZORN SMEGLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:111 S 11TH ST
Mailing Address - Street 2:STE 3390
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-6226
Mailing Address - Fax:215-923-1562
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:STE 3390
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-6226
Practice Address - Fax:215-923-1562
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2269722085R0202X
NJ25MA089836002085R0202X
PAMD4485152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102841733Medicaid
NJ0278769Medicaid
PA298461Medicare PIN