Provider Demographics
NPI:1356342372
Name:SEMELS, LISA (MSPT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:SEMELS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1568
Mailing Address - Country:US
Mailing Address - Phone:215-629-3837
Mailing Address - Fax:215-629-5531
Practice Address - Street 1:734 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1325
Practice Address - Country:US
Practice Address - Phone:610-964-1700
Practice Address - Fax:610-688-2000
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010142L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2083306000OtherBC/BS HMO
PA1394051OtherBC/BS PPO
PA000810593243OtherPHCS
PA7311639OtherAETNA
PA000810593243OtherPHCS