Individual
CARISSA ELAINE LIVINGSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 349-5200
(215) 615-3997
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 349-5200
(215) 615-3997
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MT221200
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/13/2020
Last updated
06/18/2020
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