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Individual

DR. MATTHEW ERIC LISSAUER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-6704
(410) 328-4124
Mailing address
PO BOX 64793, BALTIMORE, MD 21264-4793
(410) 328-6704
(410) 382-4124

Taxonomy

Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
69621
CT
2086S0102X
Surgical Critical Care Physician
D63229
MD
2086S0127X
Trauma Surgery Physician
Primary
69621
CT
2086S0127X
Trauma Surgery Physician
D0063229
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
408282600
MD
01
P00259987
RAILROAD MEDICARE
MD
Enumeration date
04/06/2006
Last updated
10/13/2021
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