Healthcare Provider Details

I. General information

NPI: 1801852587
Provider Name (Legal Business Name): LISA STACY THARLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NOTT ST DEPARTMENT OF HOSPITALIST MEDICINE
SCHENECTADY NY
12308
US

IV. Provider business mailing address

1101 NOTT ST DEPARTMENT OF HOSPITALIST MEDICINE
SCHENECTADY NY
12308-2489
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-4135
  • Fax: 518-243-1367
Mailing address:
  • Phone: 518-243-4135
  • Fax: 518-243-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10850
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number296320
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number296320
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number296320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: