Individual
GISELLE MARIE HALPHEN LASSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-9403
(215) 225-1698
Mailing address
5410 MARYLAND WAY, SUITE 300, BRENTWOOD, TN 37027-5064
(615) 371-5763
(888) 241-1404
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD429533
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017443500001
—
PA
05
—
1017443500002
—
PA
05
—
1017443500003
—
PA
01
—
2089055
HIGHMARK BLUE SHIELD
PA
01
—
2854904000
INDEPENDENCE BCBS
PA
Enumeration date
06/26/2006
Last updated
12/11/2009
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