Organization
LISA C OVERTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA CAROL OVERTON D.P.M. (PODIATRIST)
(215) 548-2010
Entity
Organization
Contact information
Practice address
1940 E WALNUT LN, PHILADELPHIA, PA 19138-1312
(215) 548-2113
(215) 548-3009
Mailing address
1940 E WALNUT LN, PHILADELPHIA, PA 19138-1312
(215) 548-2113
(215) 548-3009
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC004492L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001444333
HIGH MARK BLUE SHIELD ID
PA
05
—
0018442730002
—
PA
01
—
10741
ELDER HEALTH ID
PA
01
—
2134337000
10 DIGIT IBC HMO ID
PA
01
—
5403600001
DMERC SUPPLIER ID
PA
01
—
P00041340
MEDICARE RAILROAD ID
PA
Enumeration date
05/25/2006
Last updated
09/02/2011
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