Provider Demographics
NPI:1558652719
Name:LISCO, ANDREA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LISCO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 PORTER ST NW
Mailing Address - Street 2:APT E-287
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2971
Mailing Address - Country:US
Mailing Address - Phone:202-352-8633
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AV
Practice Address - Street 2:UNIVERSITY HOSPITALS OF CLEVELAND
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-6031
Practice Address - Country:US
Practice Address - Phone:216-844-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program