Provider Demographics
NPI:1881645562
Name:FORGIONE, LISA MARIE
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:FORGIONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-3059
Mailing Address - Country:US
Mailing Address - Phone:315-243-2251
Mailing Address - Fax:
Practice Address - Street 1:35 SOUTHPOINTE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5956
Practice Address - Country:US
Practice Address - Phone:864-288-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33104207Q00000X
NC2006-01138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine