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 1:1887 LITITZ PIKE STE 1
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6516
Mailing Address - Country:US
Mailing Address - Phone:917-414-2886
Mailing Address - Fax:717-947-4536
Practice Address - Street 1:1887 LITITZ PIKE STE 1
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:917-414-2886
Practice Address - Fax:717-947-4536
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453766207LP2900X
NY219993207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02410373Medicaid
NY8L4091Medicare ID - Type Unspecified
NY02410373Medicaid