Provider Demographics
NPI:1942214226
Name:COLIMON, LIZA M (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:M
Last Name:COLIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:MARIE
Other - Last Name:SWEDARSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-4840
Mailing Address - Fax:
Practice Address - Street 1:21 COLUMBIA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1133
Practice Address - Country:US
Practice Address - Phone:321-841-5560
Practice Address - Fax:321-841-2442
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229607207V00000X
FLME103808207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBZ170XMedicare PIN