Provider Demographics
NPI:1770569287
Name:LEBISCHAK, J. DORIS (MD)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:DORIS
Last Name:LEBISCHAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:
Other - Last Name:LEBISCHAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12 PAINTERS LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5504
Mailing Address - Country:US
Mailing Address - Phone:610-651-0993
Mailing Address - Fax:610-651-0993
Practice Address - Street 1:12 PAINTERS LN
Practice Address - Street 2:
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-5504
Practice Address - Country:US
Practice Address - Phone:610-651-0993
Practice Address - Fax:610-651-0993
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039935L2084F0202X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7501230Medicaid
PAF48429Medicare UPIN