Provider Demographics
NPI:1962465021
Name:PAPPAS, LANISSA M (MD)
Entity type:Individual
Prefix:MS
First Name:LANISSA
Middle Name:M
Last Name:PAPPAS
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 1:2150 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3846
Mailing Address - Country:US
Mailing Address - Phone:419-291-2200
Mailing Address - Fax:419-479-3298
Practice Address - Street 1:2150 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3846
Practice Address - Country:US
Practice Address - Phone:419-291-2200
Practice Address - Fax:419-479-3298
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
OH35-092927207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2946272Medicaid
MI1962465021Medicaid
OH2946272Medicaid