Provider Demographics
NPI:1285876532
Name:ZISA, AMY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:ZISA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:GASTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:655 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1242
Mailing Address - Country:US
Mailing Address - Phone:617-253-1505
Mailing Address - Fax:
Practice Address - Street 1:77 MASS AVE
Practice Address - Street 2:BLDG. E23-193
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-253-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD467517208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics