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Individual

LISA ANN MEDVETZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1113 HOSPITAL DR, SUITE 100, WILLINGBORO, NJ 08046-1103
(609) 835-5821
(609) 835-5827
Mailing address
500 GROVE ST, SUITE 100, HADDON HEIGHTS, NJ 08035-1761
(856) 796-9200
(856) 796-9397

Taxonomy

Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
MD060721-L
PA
208600000X
Surgery Physician
Primary
25MA06954000
NJ
208600000X
Surgery Physician
51460
KY
208600000X
Surgery Physician
M-13032
ID
208600000X
Surgery Physician
MD060721L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0017932090008
PA
01
113499
BCBS
PA
05
8239606
NJ
Enumeration date
07/19/2005
Last updated
09/01/2023
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