Healthcare Provider Details

I. General information

NPI: 1427050665
Provider Name (Legal Business Name): LISA ANN MARTIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LISA ANN LENNON

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HYGEIA DR
NEWARK DE
19713-2049
US

IV. Provider business mailing address

201 LAUREL RD
MILLSBORO DE
19966-1732
US

V. Phone/Fax

Practice location:
  • Phone: 302-273-1701
  • Fax: 302-273-4497
Mailing address:
  • Phone: 302-934-7344
  • Fax: 302-934-7345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0058234
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0005747
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: