Provider Demographics
NPI:1851511471
Name:PFINGSTLER, LISA FAIRMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:FAIRMAN
Last Name:PFINGSTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIANNE
Other - Last Name:FAIRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 BEAVER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2515
Mailing Address - Country:US
Mailing Address - Phone:814-371-7546
Mailing Address - Fax:814-371-1906
Practice Address - Street 1:105 BEAVER DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2515
Practice Address - Country:US
Practice Address - Phone:814-371-7546
Practice Address - Fax:814-371-1906
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMA052897363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1076165OtherNCCPA CERTIFICATE