Active NPI
Lisa Lynette Hostetler, M.D., PHD
- Dermatology Physician
- Glen Mills, PA
National Provider Identifier
1780760835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MD047581L
- Practice address
- 500 Evergreen Drive
Suite 20
Glen Mills, PA 19342 - Phone
- (484) 785-3376
- Fax
- (610) 544-8655
- NPI assigned
- Oct 31, 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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MD047581L | PA | Primary |
Addresses
Primary practice location
500 Evergreen Drive
Suite 20
Glen Mills, PA 19342
Mailing address
500 Evergreen Dr
Suite 20
Glen Mills, PA 19342-1032
Phone (484) 785-3376
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 469367 | Other | PA | AETNA |
| 0233208000 | Other | PA | IBC |
| 421165 | Other | PA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410307200000",
"number": "1780760835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 EVERGREEN DR",
"address_2": "SUITE 20",
"city": "GLEN MILLS",
"state": "PA",
"postal_code": "193421032",
"telephone_number": "484-785-3376",
"fax_number": "610-544-8655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 EVERGREEN DRIVE",
"address_2": "SUITE 20",
"city": "GLEN MILLS",
"state": "PA",
"postal_code": "19342",
"telephone_number": "484-785-3376",
"fax_number": "610-544-8655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOSTETLER",
"first_name": "LISA",
"middle_name": "LYNETTE",
"credential": "M.D., PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-31",
"last_updated": "2014-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "PA",
"license": "MD047581L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "469367",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IBC",
"identifier": "0233208000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "421165",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glen Mills, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.