Provider Demographics
NPI:1124021944
Name:SPLITTSTOESSER, LISA S (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:SPLITTSTOESSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 APAPANE ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-9611
Mailing Address - Country:US
Mailing Address - Phone:808-634-7006
Mailing Address - Fax:
Practice Address - Street 1:19 SAINT ANDREWS LN
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1732
Practice Address - Country:US
Practice Address - Phone:207-633-7820
Practice Address - Fax:207-810-4966
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD27782207R00000X
HIMD27782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI11865OtherSTATE LICENSE
HI11865OtherSTATE LICENSE
CA00A845440Medicare ID - Type UnspecifiedPROVIDER NUMBER
HI11865OtherSTATE LICENSE
CAH72135Medicare UPIN