Individual
ANNA C LYSIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8001 ROOSEVELT BLVD, SUITE 303, PHILADELPHIA, PA 19152-3038
(215) 332-9880
(215) 332-9880
Mailing address
8001 ROOSEVELT BLVD, SUITE 303, PHILADELPHIA, PA 19152-3038
(215) 332-9880
(215) 332-9880
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD038516L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009532460001
—
PA
01
—
0054209001
BCBS
PA
01
—
07089
SENIOR PARTNERS
PA
01
—
47998
KEYSTONE MERCY
PA
Enumeration date
03/23/2007
Last updated
07/08/2007
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