MEDICARE: DR. LISA MARIA WILLIAMSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	224541	NY

General Provider Information

NPI Number	:	1679672752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIA WILLIAMSON M.D.

Provider Business Mailing Address
First Line	:	21902 LINDEN BLVD
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1619
Country	:	US
Telephone Number	:	718-977-2273
Fax Number	:	718-977-1302

Provider Business Practice Location Address
First Line	:	21902 LINDEN BLVD
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1619
Country	:	US
Telephone Number	:	718-977-2273
Fax Number	:	718-977-1302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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