Provider Demographics
NPI:1235160599
Name:POMERLEAU, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:POMERLEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:SUMME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3301 MERCY HEALTH BLVD
Mailing Address - Street 2:STE. 340
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1105
Mailing Address - Country:US
Mailing Address - Phone:513-981-5922
Mailing Address - Fax:513-385-6430
Practice Address - Street 1:3301 MERCY HEALTH BLVD
Practice Address - Street 2:STE. 340
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1105
Practice Address - Country:US
Practice Address - Phone:513-981-5922
Practice Address - Fax:513-385-6430
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0147773Medicaid
OHSU0784366Medicare ID - Type Unspecified
OHF95761Medicare UPIN