Provider Demographics
NPI:1518913433
Name:BEAULE, LISA T (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:T
Last Name:BEAULE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:100 BRICKHILL AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1999
Practice Address - Country:US
Practice Address - Phone:207-773-1728
Practice Address - Fax:207-772-4062
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-01-03
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Provider Licenses
StateLicense IDTaxonomies
ME015332208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
QX7084Medicare PIN
MEP00690134Medicare PIN
MEMM834301Medicare PIN
H18515Medicare UPIN
ME339020099Medicare PIN