Provider Demographics
NPI:1629131685
Name:BELISLE, LISA M (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:BELISLE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4 HORTON PL
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1747
Mailing Address - Country:US
Mailing Address - Phone:207-798-6200
Mailing Address - Fax:207-798-6290
Practice Address - Street 1:4 HORTON PL
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1747
Practice Address - Country:US
Practice Address - Phone:207-798-6200
Practice Address - Fax:207-798-6290
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEMD14998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG96445Medicare UPIN