Individual
DR. LISA CAROL OVERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
1940 E WALNUT LN, PHILADELPHIA, PA 19138-1312
(215) 548-2113
(215) 548-3009
Mailing address
1940 E WALNUT LN, PHILADELPHIA, PA 19138-1312
(215) 548-2113
(215) 548-3009
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC004492L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001372137
HIGHMARK BLUE SHIELD ID
PA
05
—
0018442730002
—
PA
01
—
10741
ELDER HEALTH ID
PA
01
—
2063808000
IBC 10 DIGIT HMO ID
PA
01
—
5403600001
DMERC SUPPLIER ID
PA
Enumeration date
05/26/2006
Last updated
07/08/2011
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