License holder summary

LISA MARIE BANTA is a Graduate Medical Trainee licensed to practice in Pennsylvania. The address on file for LISA MARIE BANTA is Ellington CT 06029. This medical practitioner license is not current. The license was granted 06/25/2002 and expired on 06/25/2003.

Department of State

Board of Medicine

LISA MARIE BANTA
Graduate Medical Trainee
License number
MT179595
Date granted
06/25/2002
Date expires
06/25/2003
Class
Graduate Medical Trainee
Status
Inactive
Address
Ellington CT 06029
medicinepa.com
ID 37520210
LAST UPDATED 2024-02-13 18:35:21 UTC

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