Provider Demographics
NPI:1801852587
Name:THARLER, LISA STACY (DO)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:STACY
Last Name:THARLER
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Gender:F
Credentials:DO
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Mailing Address - Street 1:1101 NOTT ST
Mailing Address - Street 2:DEPARTMENT OF HOSPITALIST MEDICINE
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2489
Mailing Address - Country:US
Mailing Address - Phone:518-243-4135
Mailing Address - Fax:518-243-1367
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:DEPARTMENT OF HOSPITALIST MEDICINE
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308
Practice Address - Country:US
Practice Address - Phone:518-243-4135
Practice Address - Fax:518-243-1367
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2019-04-11
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Provider Licenses
StateLicense IDTaxonomies
CAAC10850171100000X
NY296320208000000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No171100000XOther Service ProvidersAcupuncturist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05431883Medicaid