Provider Demographics
NPI:1467453514
Name:CANTER, LISA T (MD,FACC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:T
Last Name:CANTER
Suffix:
Gender:F
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 KENNEDY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1946
Mailing Address - Country:US
Mailing Address - Phone:860-963-7519
Mailing Address - Fax:860-963-0668
Practice Address - Street 1:37 KENNEDY DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1854
Practice Address - Country:US
Practice Address - Phone:860-963-7519
Practice Address - Fax:860-963-0668
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036843207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001368431Medicaid
CT001368431Medicaid
CTCM3360Medicare PIN
MAA35810Medicare PIN
CT060001224Medicare PIN