Provider Demographics
NPI:1124095682
Name:SAYOC, LISA MARIE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SAYOC
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 1:4565 DRESSLER NWRD LL3
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2579
Mailing Address - Country:US
Mailing Address - Phone:330-491-4700
Mailing Address - Fax:
Practice Address - Street 1:4565 DRESSLER NWRD LL3
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2579
Practice Address - Country:US
Practice Address - Phone:330-491-4700
Practice Address - Fax:330-497-0667
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350755495207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2247232Medicaid
OH2247232Medicaid