Provider Demographics
NPI:1740396027
Name:WALK-REINARD, LISA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LYNN
Last Name:WALK-REINARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 1/2 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1802
Mailing Address - Country:US
Mailing Address - Phone:315-536-3362
Mailing Address - Fax:315-536-6836
Practice Address - Street 1:207 1/2 LAKE ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1802
Practice Address - Country:US
Practice Address - Phone:315-536-3362
Practice Address - Fax:315-536-6836
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02080591Medicaid
NYH09608Medicare UPIN
NY02080591Medicaid