Active NPI
Lisa Jill Doherty, DO
- Family Medicine Physician
- Walnutport, PA
National Provider Identifier
1447356357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS008045L
- Practice address
- 330 N Best Ave
Walnutport, PA 18088-1205 - Phone
- (610) 760-8080
- Fax
- (610) 760-8148
- NPI assigned
- Sep 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS008045L | PA | Primary |
Addresses
Primary practice location
330 N Best Ave
Walnutport, PA 18088-1205
Mailing address
330 N. Best Ave.
Suite a
Walnutport, PA 18088-1205
Phone (610) 760-8080
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0015096280008 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS008045L | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Luke'S Warren Physician Group, PC | Past | Accepting new patients | |
| Warren Health Care Alliance, PC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- NPI 1568347201
-
- Internal Medicine Physician
- Phillipsburg, NJ
- NPI 1568408490
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350604800000",
"number": "1447356357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 N. BEST AVE.",
"address_2": "SUITE A",
"city": "WALNUTPORT",
"state": "PA",
"postal_code": "180881205",
"telephone_number": "610-760-8080",
"fax_number": "610-760-8148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 N BEST AVE",
"city": "WALNUTPORT",
"state": "PA",
"postal_code": "180881205",
"telephone_number": "610-760-8080",
"fax_number": "610-760-8148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOHERTY",
"first_name": "LISA",
"middle_name": "JILL",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-16",
"last_updated": "2012-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "OS008045L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0015096280008",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Walnutport, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.