Lisa Affatato-Bradley, MD
Individual provider Active NPI Internal Medicine Physician · Rockledge, PA
NPI 1285639724 · NPPES record last updated Oct 3, 2017
Key facts
- NPI
- 1285639724
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MD056730L (PA)
- Practice address
- 400 Huntingdon Pike Ste C
Rockledge, PA 19046-4431 - Phone
- (215) 780-2000
- Fax
- (215) 780-2007
- NPI assigned
- Jun 20, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200806001877 | PA | Order and Referring Only - Internal Medicine |
2365344496 |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD056730L | PA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peter Vassalluzzo D.O. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD056730L | PA | Yes |
Addresses
Primary practice location
400 Huntingdon Pike Ste C
Rockledge, PA 19046-4431
Mailing address
400 Huntingdon Pike Ste C
Rockledge, PA 19046-4431
Phone (215) 780-2000
Other providers in Rockledge, PA
- Emily Abramson-Chen
- Christopher John Adamski
- Alyssa Alicea
- Diane Batchelor-Everett
- Amy Pauline Bell
- Kathleen Carr
- Lisa Cataldi
All providers in Rockledge, PA · Internal Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.