Provider Demographics
NPI:1083692529
Name:LISCIO, ROBERT THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:LISCIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:92 RANGER RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-6012
Mailing Address - Country:US
Mailing Address - Phone:603-883-4636
Mailing Address - Fax:603-883-6854
Practice Address - Street 1:8 E PEARL ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3461
Practice Address - Country:US
Practice Address - Phone:603-883-4636
Practice Address - Fax:603-883-6854
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH51882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000272Medicaid
NHE11269Medicare UPIN
NH80000272Medicaid