Lisa T Marrache, MD
Individual provider Active NPI Family Medicine Physician · Waterville, ME
NPI 1124130638 · NPPES record last updated Mar 17, 2008
Key facts
- NPI
- 1124130638
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 015761 (ME)
- Practice address
- 109 Silver St
Waterville, ME 04901 - Phone
- (207) 872-0866
- Fax
- (207) 872-8098
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160119002537 | ME | Order and Referring Only - Family Practice |
8123099785 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015761 | ME | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elm City Medical Associates | Family Medicine | Past | Accepting new patients |
| Penobscot Valley Hospital | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/5664/brand/1/csg/1/fhir/r4
- https://fhir-usa.unify.chbase.com/org/penob-eadbba22
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 015761 | ME | Yes |
Addresses
Primary practice location
109 Silver St
Waterville, ME 04901
Mailing address
109 Silver St
Waterville, ME 04901
Phone (207) 872-0866
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 132890099 | Medicaid | ME | |
| 027974 | Other | ME | ANTHEM |
Other providers in Waterville, ME
- George William Manter
- Sharon L. Marble
- Mallori Margaret Marcotte
- John L Margolis
- Corrie Anne Marinaro
- Ronnie C Marrache
- Candace M Marriner
- Deborah Ann Martin
- Diana L Martin
- Maureen Martin
All providers in Waterville, ME · Family Medicine Physician in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.