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General NPI Number Information
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NPI Number | 1619923190
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Entity Type | Individual
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Provider Name | LISA CAROL OVERTON D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 07/08/2011
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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 |
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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 | 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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