Individual
ELLEN SEGAL LISMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2701 HOLME AVE, SUITE 203, PHILADELPHIA, PA 19152-2029
(215) 331-0515
(215) 331-8144
Mailing address
2701 HOLME AVE, SUITE 203, PHILADELPHIA, PA 19152-2029
(215) 331-0515
(215) 331-8144
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MA003319L
PA
363AM0700X
Medical Physician Assistant
MA003319L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1045793
PHYSICIAN ASST LICENSE #
PA
Enumeration date
06/07/2006
Last updated
11/03/2010
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