Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD073683L | PA |
Y | 111NI0900X | Internist | MD073683L | PA |
N | 207RG0300X | Geriatric Medicine | MD073683L | PA |
NPI | 1164493300 |
---|---|
Provider Name | Dr. Lisa A Sardanopoli |
First Address | Wynnewood, PA 19096-3450 |
Second Address | Wynnewood, PA 19096-3450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 20/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F79220 | (02) |