Healthcare Provider Details

I. General information

NPI: 1376722892
Provider Name (Legal Business Name): LISA SPEAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SANSOM ST STE 239
PHILADELPHIA PA
19107-5002
US

IV. Provider business mailing address

1020 SANSOM ST STE 239
PHILADELPHIA PA
19107-5002
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6844
  • Fax: 215-955-2526
Mailing address:
  • Phone: 215-955-6844
  • Fax: 215-955-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.119481
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD439755
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: