Provider Demographics
NPI:1023125069
Name:DUCKER, LISA MICHELLE (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELLE
Last Name:DUCKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:930 TOWN CENTER DR
Mailing Address - Street 2:SUITE G 10
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3503
Mailing Address - Country:US
Mailing Address - Phone:215-750-8373
Mailing Address - Fax:215-750-0455
Practice Address - Street 1:930 TOWN CENTER DR
Practice Address - Street 2:SUITE G 10
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3503
Practice Address - Country:US
Practice Address - Phone:215-750-8373
Practice Address - Fax:215-750-0455
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007424L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2081180001OtherKEYSTONE
PA047374OtherAETNA
PA1142609OtherUNITED HEALTH CARE
PA1382447OtherPERSONAL CHOICE
PA2081180001OtherKEYSTONE
PADU727426Medicare ID - Type Unspecified