Provider Demographics
NPI:1508861014
Name:MAKRIDES, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MAKRIDES
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 1:28 PINTAIL TURN
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543
Mailing Address - Country:US
Mailing Address - Phone:917-414-2886
Mailing Address - Fax:
Practice Address - Street 1:1887 LITITZ PIKE STE 3
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6516
Practice Address - Country:US
Practice Address - Phone:179-474-3257
Practice Address - Fax:717-947-4536
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219993207L00000X
PAMD453766207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02410373Medicaid
NY8L4091Medicare ID - Type Unspecified
NY02410373Medicaid