Provider Demographics
NPI:1023015559
Name:KAMERLING, LISA BENAY (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BENAY
Last Name:KAMERLING
Suffix:
Gender:F
Credentials:MD
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 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1092 MADISON AVE
Practice Address - Street 2:ST. PETER'S HEALTH CARE FOR CHILDREN
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2248
Practice Address - Country:US
Practice Address - Phone:518-525-2445
Practice Address - Fax:518-475-7069
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228461208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02440233Medicaid
H91145Medicare UPIN
NY02440233Medicaid