Provider Demographics
NPI:1154397875
Name:BUNIN, LISA S (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:BUNIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1611 POND RD
Mailing Address - Street 2:STE 403
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2258
Mailing Address - Country:US
Mailing Address - Phone:610-435-5333
Mailing Address - Fax:610-435-2253
Practice Address - Street 1:1611 POND RD
Practice Address - Street 2:STE 403
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-435-5333
Practice Address - Fax:610-435-2253
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD042364E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001952477Medicaid
E21914Medicare UPIN
PA001952477Medicaid