Provider Demographics
NPI:1114058963
Name:PLUNKETT, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PLUNKETT
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 1:1100 WESCOTT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4600
Mailing Address - Country:US
Mailing Address - Phone:908-788-6535
Mailing Address - Fax:908-788-6536
Practice Address - Street 1:1100 WESCOTT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4600
Practice Address - Country:US
Practice Address - Phone:908-788-6535
Practice Address - Fax:908-788-6536
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08092800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine