Individual
LISA R THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
119 GANNETT DR, SOUTH PORTLAND, ME 04106-6942
(207) 774-2642
(207) 774-4293
Mailing address
301C US ROUTE ONE, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD15368
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038667
ANTHEM
—
05
—
269070099
—
ME
05
—
30201604
—
NH
Enumeration date
06/23/2006
Last updated
06/26/2012
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