Provider Demographics
NPI:1538191846
Name:LISKA, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LISKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:A
Other - Last Name:LISKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:37 EDGERTON DRIVE
Mailing Address - Street 2:STE 1
Mailing Address - City:NORTH FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556
Mailing Address - Country:US
Mailing Address - Phone:508-563-2550
Mailing Address - Fax:508-563-2570
Practice Address - Street 1:37 EDGERTON DRIVE
Practice Address - Street 2:STE 1
Practice Address - City:NORTH FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556
Practice Address - Country:US
Practice Address - Phone:508-563-2550
Practice Address - Fax:508-563-2570
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75627207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA725035OtherTUFTS
MA4190OtherHARVARD PILGRIM
MA3095479Medicaid
E38032Medicare UPIN
MA3095479Medicaid