Individual
DR. SEAN AARON LISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
333 CEDAR ST RM TE2, YNHH DEPARTMENT OF RADIOLOGY, NEW HAVEN, CT 06510-3206
(203) 785-5253
Mailing address
20 YORK ST, NEW HAVEN, CT 06510-3202
(203) 785-5253
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
66770
CT
2085P0229X
Pediatric Radiology Physician
66770
CT
2085R0202X
Diagnostic Radiology Physician
Primary
66770
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
66770
CONNECTICUT MEDICAL LICENSE
CT
Enumeration date
04/08/2014
Last updated
09/16/2020
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