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General NPI Number Information
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NPI Number | 1770668816
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Entity Type | Individual
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Provider Name | ELISA MIRANDA SISON IRISARI MD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 119 JEFFERSON AVE
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City | MOUNDSVILLE
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State | WV
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Zip | 26041-1410
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Country | US
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Telephone | 304-845-8555
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Fax | 304-843-1008
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Provider Business Mailing Address
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Address Line | 2000 EOFF ST
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City | WHEELING
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State | WV
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Zip | 26003-3823
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Country | US
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Telephone | 304-234-8663
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Fax | 304-234-8960
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 11087
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0108761
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License Number State | OH
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