Healthcare Provider Details

I. General information

NPI: 1518955509
Provider Name (Legal Business Name): LISA KEGLOVITZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 W TILGHMAN ST SUITE 250
ALLENTOWN PA
18104-9130
US

IV. Provider business mailing address

4905 W TILGHMAN ST SUITE 250
ALLENTOWN PA
18104-9130
US

V. Phone/Fax

Practice location:
  • Phone: 484-866-9583
  • Fax: 610-366-1147
Mailing address:
  • Phone: 484-866-9583
  • Fax: 610-366-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD070447L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: