Individual
LIEZL G. IRISARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11107 RACETRACK RD, BERLIN, MD 21811-3279
(410) 208-9761
(410) 208-9764
Mailing address
10026 OLD OCEAN CITY BLVD, BUILDING #1, BERLIN, MD 21811-1288
(410) 641-9450
(410) 641-9515
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
230999
MA
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
230999
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110076111A
—
MA
Enumeration date
06/22/2006
Last updated
06/21/2019
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