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General NPI Number Information
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NPI Number | 1205044948
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Entity Type | Individual
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Provider Name | LISA J MOUDGILL MD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 01/31/2011
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Provider Practice Location Address
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Address Line | 111 S 15TH ST #1604
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2625
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Country | US
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Telephone | 215-681-2036
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Fax |
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Provider Business Mailing Address
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Address Line | 111 S 15TH ST #1604
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2625
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Country | US
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Telephone | 215-681-2036
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MT186151
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD432152
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License Number State | PA
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