Provider Demographics
NPI:1508876525
Name:GAGNE, LISA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:GAGNE
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DARTMOUTH-HITCHCOCK MEDICAL CENTER
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-788-5310
Mailing Address - Fax:603-788-3684
Practice Address - Street 1:173 MIDDLE ST
Practice Address - Street 2:DHMC-PATHOLOGY
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3508
Practice Address - Country:US
Practice Address - Phone:603-788-5310
Practice Address - Fax:603-788-3684
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10302207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200257Medicaid
VTORE5348Medicaid
VTORE5348Medicaid
NH30200257Medicaid