Provider Demographics
NPI:1164620050
Name:SIRIPUN, LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:SIRIPUN
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 648
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8648
Mailing Address - Country:US
Mailing Address - Phone:585-275-1128
Mailing Address - Fax:585-273-3549
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 648
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8648
Practice Address - Country:US
Practice Address - Phone:585-275-1128
Practice Address - Fax:585-273-3549
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program