Individual
DR. LISA R BEVILACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1882 NEW SCOTLAND RD STE 200, SLINGERLANDS, NY 12159-3627
(518) 439-2460
Mailing address
711 TROY SCHENECTADY RD STE 203, LATHAM, NY 12110-2461
(518) 782-3700
(518) 782-3799
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
191889
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000401405003
BSNENY
NY
05
—
01495192
—
NY
01
—
040824000041
FIDELIS
NY
01
—
08954
MVP
NY
01
—
10005959
CDPHP
NY
01
—
200032
SENIOR WHOLE HEALTH
NY
01
—
4725D1
EMPIRE BC
NY
01
—
52558
GHI/HMO
NY
01
—
531715
AETNA
NY
Enumeration date
09/29/2006
Last updated
05/07/2021
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