Individual
LISA LYNETTE HOSTETLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., PHD
Contact information
Practice address
500 EVERGREEN DRIVE, SUITE 20, GLEN MILLS, PA 19342
(484) 785-3376
(610) 544-8655
Mailing address
500 EVERGREEN DR, SUITE 20, GLEN MILLS, PA 19342-1032
(484) 785-3376
(610) 544-8655
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD047581L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0233208000
IBC
PA
01
—
421165
BLUE SHIELD
PA
01
—
469367
AETNA
PA
Enumeration date
10/31/2006
Last updated
09/10/2014
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