Healthcare Provider Details

I. General information

NPI: 1598722167
Provider Name (Legal Business Name): LISA A YAMAKAWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: LISA A DALSIMER

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 PHILLIP MORRIS DR
SALISBURY MD
21804-1923
US

IV. Provider business mailing address

217 PHILLIP MORRIS DR
SALISBURY MD
21804-1923
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-3173
  • Fax: 410-742-4804
Mailing address:
  • Phone: 410-546-3173
  • Fax: 410-742-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0064204
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: