Provider Demographics
NPI:1982677076
Name:LETOURNEAU, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:LETOURNEAU
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 1:465 CONGRESS ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3528
Mailing Address - Country:US
Mailing Address - Phone:207-541-7521
Mailing Address - Fax:207-541-7540
Practice Address - Street 1:465 CONGRESS ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3528
Practice Address - Country:US
Practice Address - Phone:207-541-7521
Practice Address - Fax:207-541-7540
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012683207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE19425Medicare UPIN