Provider Demographics
NPI:1992711493
Name:GALANTE, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GALANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114
Mailing Address - Country:US
Mailing Address - Phone:215-673-7070
Mailing Address - Fax:215-673-2828
Practice Address - Street 1:9501 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-673-7070
Practice Address - Fax:215-673-2828
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030536E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001007454003Medicaid
0054329000OtherIBC
PA001007454003Medicaid
127903Medicare ID - Type Unspecified