Provider Demographics
NPI:1881798874
Name:ANDERSON, LISA RE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:123 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2700
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2652
Mailing Address - Country:US
Mailing Address - Phone:207-721-8700
Mailing Address - Fax:207-721-8715
Practice Address - Street 1:121 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2700
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2653
Practice Address - Country:US
Practice Address - Phone:207-721-8700
Practice Address - Fax:207-721-8715
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2016-02-05
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Provider Licenses
StateLicense IDTaxonomies
ME014029207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102140000Medicaid
ME102140000Medicaid
MEMM6023Medicare PIN