Provider Demographics
NPI:1558359034
Name:WEISS, LISA N (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:N
Last Name:WEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:NOBLE
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8423 MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6778
Mailing Address - Country:US
Mailing Address - Phone:330-729-8700
Mailing Address - Fax:330-729-8701
Practice Address - Street 1:8423 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6778
Practice Address - Country:US
Practice Address - Phone:330-729-8700
Practice Address - Fax:330-729-8701
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.081243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2562927Medicaid
OH2562927Medicaid