Provider Demographics
NPI:1851362867
Name:PARVISKHAN, LISA F (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:F
Last Name:PARVISKHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 W LINCOLN HWY
Mailing Address - Street 2:2ND FL
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2547
Mailing Address - Country:US
Mailing Address - Phone:610-269-3790
Mailing Address - Fax:
Practice Address - Street 1:724 W LINCOLN HWY
Practice Address - Street 2:2ND FL
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2547
Practice Address - Country:US
Practice Address - Phone:610-269-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007850L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001408551Medicaid
PA232359401OtherMAIN LINE HEALTHCARE
PA406117HK1Medicare ID - Type Unspecified
PA232359401OtherMAIN LINE HEALTHCARE