Healthcare Provider Details

I. General information

NPI: 1144545195
Provider Name (Legal Business Name): LISA RENEE CHASTANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ST LUKES BLVD STE 102
EASTON PA
18045-5671
US

IV. Provider business mailing address

419 RUSSELL AVE
OCEAN SPRINGS MS
39564-4727
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-7546
  • Fax: 484-503-7547
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3284-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number26245
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number19930
License Number StateND
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD488857C
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number26245
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberC1-0009800
License Number StateDE
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC1-0009800
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: