Provider Demographics
NPI:1689747297
Name:WATSON, LISA A (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:WATSON
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2314 SASSAFRAS STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2721
Mailing Address - Country:US
Mailing Address - Phone:814-452-5043
Mailing Address - Fax:814-452-7005
Practice Address - Street 1:155 E STATE ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:PA
Practice Address - Zip Code:16401-1347
Practice Address - Country:US
Practice Address - Phone:814-756-4917
Practice Address - Fax:814-756-5226
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2024-02-07
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Provider Licenses
StateLicense IDTaxonomies
PAOS014223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021746830001Medicaid
PA1021746830002Medicaid