Healthcare Provider Details

I. General information

NPI: 1194836221
Provider Name (Legal Business Name): AMY K LANSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 WALNUT ST
PHILADELPHIA PA
19103-4609
US

IV. Provider business mailing address

PO BOX 30537
PHILADELPHIA PA
19103-8537
US

V. Phone/Fax

Practice location:
  • Phone: 215-564-2800
  • Fax: 215-564-3097
Mailing address:
  • Phone: 215-564-2800
  • Fax: 215-564-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD030479E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD030479E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD030479E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD030479E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: