Individual
LISA FAZI-DIEDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
160 E ERIE AVE, PHILADELPHIA, PA 19134-1011
(215) 427-5220
Mailing address
PO BOX 13579, READING, PA 19612-3579
(484) 628-1324
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD058440L
PA
207LP3000X
Pediatric Anesthesiology Physician
Primary
MD058440L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016760420
—
PA
Enumeration date
08/10/2006
Last updated
03/21/2023
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