Healthcare Provider Details

I. General information

NPI: 1790715654
Provider Name (Legal Business Name): MARY E LYSTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 ROUTE 27
RAYMOND NH
03077-1220
US

IV. Provider business mailing address

207 S MAIN ST
NEWMARKET NH
03857-1835
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-1626
  • Fax:
Mailing address:
  • Phone: 603-292-7292
  • Fax: 603-292-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD07115
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38126
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: