Provider Demographics
NPI:1881842466
Name:O'CONNOR, LISA MARIE (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:FLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 TWIN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-1518
Mailing Address - Country:US
Mailing Address - Phone:315-256-4659
Mailing Address - Fax:
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:CLINICAL AFFILIATES
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-2713
Practice Address - Fax:315-448-6325
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013075OtherNYS LICENSE #
NY013075OtherNYS LICENSE #
NYPTAN P00739249Medicare PIN