Basic Information
| Provider Information | |||||||||
| NPI: | 1205843505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATKINSON | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 253 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033017560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032262200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 253 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033017560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032262200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 02/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 11649 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 11649 | NH | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 2000146069 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 2000146069 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 30202189 | 05 | NH | MEDICAID |