Provider Demographics
NPI:1811969405
Name:TKATCH, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TKATCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-614-4420
Mailing Address - Fax:717-614-4421
Practice Address - Street 1:810 SIR THOMAS CT
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109
Practice Address - Country:US
Practice Address - Phone:717-614-4420
Practice Address - Fax:717-614-4421
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044469E207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001205192Medicaid
PAP00125425Medicare PIN
PA609745SRDMedicare PIN
PAE55627Medicare UPIN