MEDICARE: FREDERIC ELIOT LISS MD

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	207X00000X	Orthopaedic Surgery Physician	MD036317E	PA
2	207XS0106X	Orthopaedic Hand Surgery Physician	MD036317E	PA
3	207X00000X	Orthopaedic Surgery Physician	25MA09448300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447256680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERIC ELIOT LISS MD

Provider Business Mailing Address
First Line	:	833 CHESTNUT ST
Second Line	:	SUITE 1402
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4414
Country	:	US
Telephone Number	:	800-321-9999
Fax Number	:	267-339-3761

Provider Business Practice Location Address
First Line	:	400 MAIN ST
Second Line	:
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-3810
Country	:	US
Telephone Number	:	610-935-1120
Fax Number	:	610-935-5507

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	11/10/2015

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