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General NPI Number Information
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NPI Number | 1356397913
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Entity Type | Organization
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Legal Business Name | LISA C OVERTON
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 1940 E WALNUT LN
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City | PHILADELPHIA
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State | PA
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Zip | 19138-1312
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Country | US
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Telephone | 215-548-2113
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Fax | 215-548-3009
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Provider Business Mailing Address
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Address Line | 1940 E WALNUT LN
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City | PHILADELPHIA
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State | PA
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Zip | 19138-1312
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Country | US
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Telephone | 215-548-2113
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Fax | 215-548-3009
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. LISA CAROL OVERTON
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Credential | D.P.M.
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Telephone | 215-548-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC004492L
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License Number State | PA
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