Individual
LISA MANITTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 N BROAD ST STE C525, PHILADELPHIA, PA 19140-5103
(215) 707-6400
Mailing address
3401 N BROAD ST STE C525, PHILADELPHIA, PA 19140-5103
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MT230665
PA
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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