Healthcare Provider Details

I. General information

NPI: 1023515384
Provider Name (Legal Business Name): LISA MICHELLE FRIEDLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 07/29/2022
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SANSOM ST, SUITE 1651B
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

1020 SANSOM ST STE T239
PHILADELPHIA PA
19107-5002
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-9837
  • Fax: 215-955-9870
Mailing address:
  • Phone: 215-955-6844
  • Fax: 215-923-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD474500
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: