David Lisan, D.O.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

OS009840L Issued in PA

Practice address

913 Montgomery Ave
Penn Valley, PA 19072-1501

Phone

(610) 664-3400

Fax

(610) 664-8482

NPI assigned

Nov 8, 2006

Last updated

Dec 12, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Physical Therapy Associates, LTD.

  • Physical Therapist
  • Narberth, PA
  • NPI 1063448793
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481500800000",
    "number": "1629148945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 MONTGOMERY AVE",
            "city": "PENN VALLEY",
            "state": "PA",
            "postal_code": "190721501",
            "telephone_number": "610-664-3400",
            "fax_number": "610-664-8482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 MONTGOMERY AVE",
            "city": "PENN VALLEY",
            "state": "PA",
            "postal_code": "190721501",
            "telephone_number": "610-664-3400",
            "fax_number": "610-664-8482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISAN",
        "first_name": "DAVID",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2016-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT007501L",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "OS7820",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "DAPT001519",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT21515",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PA",
            "license": "OS009840L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Kucharczuk, MD
• Leah Charlson Pediatric OT LLC (Main Line Integrated Therapy)
• Sun Young Lee-Park, LCSW
• Lori A Lerner, MD
• Alison Fedoris Leslie, LCSW
• M. R. Baker, PC
• Main Line Audiology Consultants
• Main Line Audiology Consultants
• Richard B Marcus, PHD
• Alex Margolies

• General Practice Physician in Penn Valley, PA
• Providers in Penn Valley, PA by specialty
• General Practice Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.