Provider Demographics
NPI:1275738031
Name:SCHNETTLER, LISA ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ELAINE
Last Name:SCHNETTLER
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 1:28 JAMES ST APT B
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3819
Mailing Address - Country:US
Mailing Address - Phone:513-314-8052
Mailing Address - Fax:
Practice Address - Street 1:28 JAMES ST APT B
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3819
Practice Address - Country:US
Practice Address - Phone:513-314-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.012152208000000X
MA246647208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2961915Medicaid
OHSC4273121Medicare PIN