Provider Demographics
NPI:1891086740
Name:CUPIT, LISA DIANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DIANNE
Last Name:CUPIT
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 1:5 DEAUVILLE CT
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2105
Mailing Address - Country:US
Mailing Address - Phone:631-754-3714
Mailing Address - Fax:
Practice Address - Street 1:5 DEAUVILLE CT
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2105
Practice Address - Country:US
Practice Address - Phone:631-754-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60205687207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology