Provider Demographics
NPI:1265417091
Name:LERNER, YEVGENY (MD)
Entity type:Individual
Prefix:DR
First Name:YEVGENY
Middle Name:
Last Name:LERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4112
Mailing Address - Country:US
Mailing Address - Phone:215-413-1904
Mailing Address - Fax:
Practice Address - Street 1:2000 GRANT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4378
Practice Address - Country:US
Practice Address - Phone:215-992-6002
Practice Address - Fax:215-992-6001
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063926L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017265740034Medicaid
PA0017265740034Medicaid
G20956Medicare UPIN