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General NPI Number Information
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NPI Number | 1558799064
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Entity Type | Organization
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Legal Business Name | DELISSER MEDICAL AND CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 2095 DEEP MEADOW LN
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City | LANSDALE
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State | PA
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Zip | 19446-7409
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Country | US
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Telephone | 610-841-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 WALBERT AVE SUITE 201
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City | ALLENTOWN
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State | PA
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Zip | 18104-1700
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Country | US
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Telephone | 610-841-0400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAWTON O DELISSER
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Credential | MD
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Telephone | 610-841-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD070002L
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License Number State | PA
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