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General NPI Number Information
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NPI Number | 1457432833
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Entity Type | Individual
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Provider Name | LISA M THORN M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 3305 ROUTE 43
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City | AVERILL PARK
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State | NY
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Zip | 12018
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Country | US
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Telephone | 518-674-5797
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Fax | 518-674-2396
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Provider Business Mailing Address
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Address Line | 711 TROY SCHENECTADY RD STE 203
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City | LATHAM
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State | NY
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Zip | 12110-2461
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Country | US
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Telephone | 518-782-3700
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Fax | 518-782-3799
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 187244
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License Number State | NY
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