Provider Demographics
NPI:1699742387
Name:HARPST, LISA LYNNELLE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LYNNELLE
Last Name:HARPST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:110 PLAZA LN
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1773
Practice Address - Country:US
Practice Address - Phone:570-724-4241
Practice Address - Fax:570-724-5510
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220136207Q00000X
PAMD064476L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017357600002Medicaid
PA080160287OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
PAGU040009OtherMEDICARE GROUP
PA080160287OtherRR MEDICARE PIN
G88098Medicare UPIN
PA0017357600002Medicaid
PAGU040009OtherMEDICARE GROUP