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General NPI Number Information
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NPI Number | 1578099487
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Entity Type | Organization
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Legal Business Name | AMERICAN COMP.WEIGHT LOSS CENTER
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 719 E LANCASTER AVE SUITE 705
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-2719
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Country | US
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Telephone | 610-873-1048
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Fax | 610-873-2000
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Provider Business Mailing Address
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Address Line | 719 E LANCASTER AVE SUITE 705
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-2719
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA ANN MEDVETZ
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Credential | M.D
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Telephone | 610-873-1048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number | MD-060721-L
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License Number State | PA
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