MEDICARE: DR. LISA L DADSON DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	SC004444R	PA

General Provider Information

NPI Number	:	1336136506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA L DADSON DPM

Provider Business Mailing Address
First Line	:	411 DOGWOOD RD
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-7566
Country	:	US
Telephone Number	:	570-476-6629
Fax Number	:	570-476-6839

Provider Business Practice Location Address
First Line	:	411 DOGWOOD RD
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-7566
Country	:	US
Telephone Number	:	570-476-6629
Fax Number	:	570-476-6839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	10/16/2014

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