Provider Demographics
NPI:1437115482
Name:D'EON, LISETTE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISETTE
Middle Name:ANNE
Last Name:D'EON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:50 GETZVILLE RD
Mailing Address - Street 2:APT. C
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3516
Mailing Address - Country:US
Mailing Address - Phone:716-832-5901
Mailing Address - Fax:716-961-3713
Practice Address - Street 1:224 E MAIN ST
Practice Address - Street 2:BERTRAND CHAFFEE HOSPITAL PRIMARY CARE CLINIC
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1443
Practice Address - Country:US
Practice Address - Phone:716-592-8140
Practice Address - Fax:716-961-3713
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-12-11
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Provider Licenses
StateLicense IDTaxonomies
NY185096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01345179Medicaid
NY01345179Medicaid
NYDD4209Medicare PIN