Provider Demographics
NPI:1023014032
Name:LISZKA, ANNE-MARIE
Entity Type:Individual
Prefix:
First Name:ANNE-MARIE
Middle Name:
Last Name:LISZKA
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 1:1101 PENINSULA DR STE 202
Mailing Address - Street 2:SUITE 202 AND 203
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 PENINSULA DR STE 202
Practice Address - Street 2:SUITE 202 AND 203
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4169
Practice Address - Country:US
Practice Address - Phone:814-833-5381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006569L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012445480006Medicaid
PA675542Medicare ID - Type Unspecified
PA0012445480006Medicaid