Provider Demographics
NPI:1649385626
Name:ATTEBERY, M. LISA (DO)
Entity type:Individual
Prefix:
First Name:M. LISA
Middle Name:
Last Name:ATTEBERY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19409 PLANTATION RD STE 3
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4413
Mailing Address - Country:US
Mailing Address - Phone:302-444-0194
Mailing Address - Fax:302-200-9131
Practice Address - Street 1:19409 PLANTATION RD STE 3
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4413
Practice Address - Country:US
Practice Address - Phone:302-444-0194
Practice Address - Fax:302-200-9131
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013314208600000X
DEC2-0012056208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1349602OtherAETNA
NJ2761458OtherUNITED HEALTHCARE
NJ5733135OtherCIGNA
NJP3723047OtherOXFORD
NJP00402266OtherRR MEDICARE
NJ01077798300OtherAMERICHOICE
NJ60026355OtherHORIZON NJ HEALTH
NJ1349602OtherAETNA
NJP00402266OtherRR MEDICARE
NJ2797661000OtherAMERIHEALTH/KEYSTONE/IBC
NJ054297 ANOMedicare PIN