Provider Demographics
NPI:1427050665
Name:MARTIN, LISA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:
Credentials:DO
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:LENNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-1732
Mailing Address - Country:US
Mailing Address - Phone:302-934-7344
Mailing Address - Fax:302-934-7345
Practice Address - Street 1:200 HYGEIA DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2049
Practice Address - Country:US
Practice Address - Phone:302-273-1701
Practice Address - Fax:302-273-4497
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0058234207Q00000X
DEC2-0005747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE020607715OtherBDBSDE
DE080189947OtherRRB PALMETTO
DE1822385OtherUNITED
DE2208964001OtherAMERIHEALTH
DE23227OtherJOHNS HOPKINS
DES4540001OtherDELMARVA HEALTH
DE15039OtherMIDATLANTIC
DE187037OtherCOVENTRY
DE2273904OtherAETNA
DE6697853OtherCIGNA
DEINFORMEDOther020607715
DE890562OtherMAMSI
DES4540001OtherDELMARVA HEALTH
DEG22194Medicare UPIN