Individual
DR. LISA J STATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3401 CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILADELPHIA - RADIOLOGY, PHILADELPHIA, PA 19104-4319
(215) 590-7000
(215) 590-9348
Mailing address
100 E PENN SQ, 9TH FLOOR, PHILADELPHIA, PA 19107-3323
(267) 425-9232
(267) 425-9299
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
MD052679L
PA
2085N0904X
Nuclear Radiology Physician
MD052679L
PA
2085P0229X
Pediatric Radiology Physician
MA07027600
NJ
2085P0229X
Pediatric Radiology Physician
Primary
MD052679L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000155673(PA)
—
NJ
Enumeration date
09/29/2006
Last updated
04/18/2013
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