Individual
DR. LISA M THORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3305 ROUTE 43, AVERILL PARK, NY 12018
(518) 674-5797
(518) 674-2396
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
187244
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000401537006
BSNENY
NY
05
—
01397479
—
NY
01
—
10002042
CDPHP
NY
01
—
383845
MVP
NY
01
—
5562A1
EMPIRE BC
NY
01
—
5731176
AETNA
NY
01
—
92949
GHI/HMO
NY
01
—
FIDELIS
070129000060
NY
01
—
SENIOR WHOLE HEALTH
200249
NY
Enumeration date
10/18/2006
Last updated
01/18/2018
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