Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34011290 | OH |
N | 207Q00000X | Family Doctor | OS014900 | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | OS014900 | PA |
NPI | 1013172121 |
---|---|
Provider Name | Dr. Lisa A Malys |
First Address | Wooster, OH 44691-7126 |
Second Address | Wooster, OH 44691-7126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2008 |
Last Update Date | 16/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0104063 | (05) | OH |
H322480 | (02) | OH |