Provider Demographics
NPI:1679672752
Name:WILLIAMSON, LISA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIA
Last Name:WILLIAMSON
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 1:21902 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1619
Mailing Address - Country:US
Mailing Address - Phone:718-977-2273
Mailing Address - Fax:718-977-1302
Practice Address - Street 1:21902 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1619
Practice Address - Country:US
Practice Address - Phone:718-977-2273
Practice Address - Fax:718-977-1302
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224541208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics