Provider Demographics
NPI:1063458800
Name:WEBB, LISA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:DAISY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2456
Mailing Address - Country:US
Mailing Address - Phone:203-888-5087
Mailing Address - Fax:
Practice Address - Street 1:2590 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5838
Practice Address - Country:US
Practice Address - Phone:203-377-5988
Practice Address - Fax:203-380-0531
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0386632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH15449Medicare UPIN