Provider Demographics
NPI:1043245046
Name:SHERMAN, LISA D (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:SHERMAN
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 1:401 ANDOVER STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NO ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-691-5690
Mailing Address - Fax:978-691-5690
Practice Address - Street 1:155 BORTHWICK AVENUE
Practice Address - Street 2:SUITE 201 WEST
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-433-9575
Practice Address - Fax:603-430-0104
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051160174400000X
MA235341207N00000X
ME017869207N00000X
NH14048207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005900671Medicaid
070000221Medicare ID - Type Unspecified
VA005900671Medicaid