Provider Demographics
NPI:1053493072
Name:COLTON, LISA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:COLTON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:220 LINDEN OAKS SUITE 200
Mailing Address - Street 2:PANORAMA PEDIATRIC GROUP RLLP
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:585-381-4982
Mailing Address - Fax:585-381-1821
Practice Address - Street 1:220 LINDEN OAKS SUITE 200
Practice Address - Street 2:PANORAMA PEDIATRIC GROUP RLLP
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625
Practice Address - Country:US
Practice Address - Phone:585-381-4982
Practice Address - Fax:585-381-1821
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY202790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01662702Medicaid
NY105883DLOtherPREFERRED CARE
NY5126616OtherAETNA
NY105883DLOtherPREFERRED CARE
NYI46878Medicare UPIN