Individual
DR. LISA MARIE FAHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3401 CIVIC CENTER BLVD, DIVISION OF PEDIATRIC GASTROENTEROLOGY, PHILADELPHIA, PA 19104-4319
(215) 590-3630
Mailing address
3401 CIVIC CENTER BLVD, DIVISION OF GASTROENTEROLOGY, PHILADELPHIA, PA 19104-4319
(215) 590-3600
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
MT205490
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/09/2011
Last updated
05/10/2015
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