Provider Demographics
NPI:1700865045
Name:GLEASON, LISA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2600 VIA DE LA VALLE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1992
Mailing Address - Country:US
Mailing Address - Phone:858-939-6561
Mailing Address - Fax:858-874-2379
Practice Address - Street 1:2600 VIA DE LA VALLE
Practice Address - Street 2:SUITE 200
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1992
Practice Address - Country:US
Practice Address - Phone:858-939-6561
Practice Address - Fax:858-874-2379
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC35560207R00000X
CAA65766207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease