Provider Demographics
NPI:1366490039
Name:GAFFNEY, LISAANN (MD)
Entity Type:Individual
Prefix:
First Name:LISAANN
Middle Name:
Last Name:GAFFNEY
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 1:321 GIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-3201
Mailing Address - Country:US
Mailing Address - Phone:315-703-2600
Mailing Address - Fax:315-703-2621
Practice Address - Street 1:321 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3201
Practice Address - Country:US
Practice Address - Phone:315-703-2600
Practice Address - Fax:315-703-2621
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2007961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01617629Medicaid
G21257Medicare UPIN