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General NPI Number Information
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NPI Number | 1538191846
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Entity Type | Individual
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Provider Name | MARK A LISKA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 37 EDGERTON DRIVE STE 1
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City | NORTH FALMOUTH
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State | MA
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Zip | 02556
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Country | US
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Telephone | 508-563-2550
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Fax | 508-563-2570
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Provider Business Mailing Address
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Address Line | 37 EDGERTON DRIVE STE 1
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City | NORTH FALMOUTH
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State | MA
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Zip | 02556
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Country | US
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Telephone | 508-563-2550
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Fax | 508-563-2570
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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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 75627
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 75627
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License Number State | MA
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