Provider Demographics
NPI:1245296169
Name:DRUCTOR, LISA ANN (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DRUCTOR
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 E EVESHAM RD STE 306
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4503
Mailing Address - Country:US
Mailing Address - Phone:856-554-3822
Mailing Address - Fax:856-554-3823
Practice Address - Street 1:1418 NEW RD STE 1C
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1179
Practice Address - Country:US
Practice Address - Phone:609-699-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08322700207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2603403Medicaid
PA0017450230001Medicaid
NJ0455091OtherGROUP MEDICAID
NJ381020OtherGROUP MEDICARE
NJ140858ZK8MMedicare PIN
NJ381020OtherGROUP MEDICARE