Individual
LISA SPACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1015 CHESTNUT ST STE 1020, PHILADELPHIA, PA 19107-4310
(215) 955-7785
(215) 923-9362
Mailing address
PO BOX 64264, BALTIMORE, MD 21264-4264
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
D57907
MD
207RI0200X
Infectious Disease Physician
Primary
MD433099
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
406954400
—
MD
Enumeration date
06/27/2006
Last updated
10/25/2017
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