Provider Demographics
NPI:1710952148
Name:ROESKE-ANDERSON, LISA C (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:C
Last Name:ROESKE-ANDERSON
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 1:499 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2780
Mailing Address - Country:US
Mailing Address - Phone:303-781-4485
Mailing Address - Fax:720-274-0064
Practice Address - Street 1:499 E HAMPDEN AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2780
Practice Address - Country:US
Practice Address - Phone:303-781-4485
Practice Address - Fax:720-274-0064
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069258L174400000X
CO519112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001774080Medicaid
PAG55949Medicare UPIN
PA032900E5YMedicare PIN
PA032900E5YMedicare ID - Type Unspecified