Provider Demographics
NPI:1841382835
Name:LERA AYOTTE, LIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:LIANA
Middle Name:
Last Name:LERA AYOTTE
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 1:2966 STREET RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2604
Mailing Address - Country:US
Mailing Address - Phone:215-638-0666
Mailing Address - Fax:215-638-3320
Practice Address - Street 1:2966 STREET RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2604
Practice Address - Country:US
Practice Address - Phone:215-638-0666
Practice Address - Fax:215-638-3320
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445607207P00000X
NY240174207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00479236Medicare PIN