Provider Demographics
NPI:1265881676
Name:TOM, LISA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:TOM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PILLSBURY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3549
Mailing Address - Country:US
Mailing Address - Phone:603-224-2020
Mailing Address - Fax:603-228-7061
Practice Address - Street 1:5454 WISCONSIN AVE STE 950
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6912
Practice Address - Country:US
Practice Address - Phone:301-657-5700
Practice Address - Fax:301-654-9132
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0095596207W00000X, 207WX0009X
FLME145348207W00000X
NH21488207WX0009X
DCMD210002800207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology