Provider Demographics
NPI:1992888218
Name:DEMARCHE, LISA A (RPA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:DEMARCHE
Suffix:
Gender:F
Credentials:RPA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2004
Mailing Address - Street 2:CROUSE RADIOLOGY ASSOCIATES, LLP
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4504
Mailing Address - Country:US
Mailing Address - Phone:315-470-7551
Mailing Address - Fax:315-470-2719
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:CROUSE RADIOLOGY ASSOCIATES, LLP
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1687
Practice Address - Country:US
Practice Address - Phone:315-470-7551
Practice Address - Fax:315-470-2719
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-08-15
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Provider Licenses
StateLicense IDTaxonomies
NY011612363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400231560Medicare PIN
NYPA2664Medicare PIN