Provider Demographics
NPI:1336136506
Name:DADSON, LISA L (DPM)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:DADSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7566
Mailing Address - Country:US
Mailing Address - Phone:570-476-6629
Mailing Address - Fax:570-476-6839
Practice Address - Street 1:411 DOGWOOD RD
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7566
Practice Address - Country:US
Practice Address - Phone:570-476-6629
Practice Address - Fax:570-476-6839
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004444R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA047010SZUMedicare PIN
PAU84562Medicare UPIN