Healthcare Provider Details

I. General information

NPI: 1922298033
Provider Name (Legal Business Name): LISA MARIE KOBELIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA MARIE ZIMMERMAN PA-C

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

IV. Provider business mailing address

289 S MARKET ST
ELYSBURG PA
17824-9447
US

V. Phone/Fax

Practice location:
  • Phone: 570-837-2123
  • Fax: 570-837-2185
Mailing address:
  • Phone: 570-672-9885
  • Fax: 570-672-9856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA000937
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051261
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: