Provider Demographics
NPI:1992998553
Name:DRIES, LISA MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:DRIES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-0589
Mailing Address - Country:US
Mailing Address - Phone:207-467-5588
Mailing Address - Fax:
Practice Address - Street 1:50 PORTLAND RD STE 4
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6789
Practice Address - Country:US
Practice Address - Phone:207-502-3583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD2054207V00000X
MEDO2054208D00000X
MED02054207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433002499Medicaid
ME010179500OtherMEDICAL NETWORK OF MAINE
010179500OtherFIRST HEALTH/COVENTRY NETWORK
ME9291182OtherAETNA
ME1986548OtherCIGNA
MEAA123722OtherHARVARD PILGRIM HEALTHCARE
ME1992998553OtherANTHEM
ME1986548OtherCIGNA