MEDICARE: LISA FERENCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD044667L	PA

General Provider Information

NPI Number	:	1336112515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA FERENCE

Provider Business Mailing Address
First Line	:	833 STATE ROUTE 130
Second Line	:
City	:	TRAFFORD
State	:	PA
Zip	:	15085-9700
Country	:	US
Telephone Number	:	412-856-7332
Fax Number	:

Provider Business Practice Location Address
First Line	:	833 STATE ROUTE 130
Second Line	:
City	:	TRAFFORD
State	:	PA
Zip	:	15085-9700
Country	:	US
Telephone Number	:	412-856-7332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	10/03/2024

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Directions to “ LISA FERENCE ” Practice Location

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