Provider Demographics
NPI:1255424669
Name:LISA M. DUCKER DO
Entity type:Organization
Organization Name:LISA M. DUCKER DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-750-8373
Mailing Address - Street 1:930 TOWN CENTER DR STE G10
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3504
Mailing Address - Country:US
Mailing Address - Phone:215-750-8373
Mailing Address - Fax:215-750-0455
Practice Address - Street 1:930 TOWN CENTER DR STE G10
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3504
Practice Address - Country:US
Practice Address - Phone:215-750-8373
Practice Address - Fax:215-750-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007424L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty