Basic Information
| Provider Information | |||||||||
| NPI: | 1447256680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LISS | ||||||||
| FirstName: | FREDERIC | ||||||||
| MiddleName: | ELIOT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT ST | ||||||||
| Address2: | SUITE 1402 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003219999 | ||||||||
| FaxNumber: | 2673393761 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194603810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109351120 | ||||||||
| FaxNumber: | 6109355507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD036317E | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | MD036317E | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207X00000X | 25MA09448300 | NJ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1292527 | 05 | PA | MEDICAID |