Provider Demographics
NPI:1023227444
Name:LEVIN MIZRAHI, LISSA BETH (MD)
Entity type:Individual
Prefix:DR
First Name:LISSA
Middle Name:BETH
Last Name:LEVIN MIZRAHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISSA
Other - Middle Name:BETH
Other - Last Name:LEVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1320
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:216 N BROAD ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1121
Practice Address - Country:US
Practice Address - Phone:215-762-2688
Practice Address - Fax:215-762-2689
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435759207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherRR MEDICARE
PA597586OtherMEDICARE GROUP
PA1007278000113OtherMA GROUP TEMPLE PHYSICIANS INC