MEDICARE: LISA MARII COOKINGHAM MD

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	207VE0102X	Reproductive Endocrinology Physician	2024-00952	NC
2	207VG0400X	Gynecology Physician	MD-40111	IA
3	207V00000X	Obstetrics & Gynecology Physician	70191	AZ
4	207VE0102X	Reproductive Endocrinology Physician	83564	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70192	OTHER	AZ	TRAINING PERMIT

General Provider Information

NPI Number	:	1134383128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARII COOKINGHAM MD

Provider Business Mailing Address
First Line	:	7920 ACC BLVD STE 300
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-8744
Country	:	US
Telephone Number	:	919-908-0000
Fax Number	:	919-596-6147

Provider Business Practice Location Address
First Line	:	7920 ACC BLVD STE 300
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-8744
Country	:	US
Telephone Number	:	919-908-0000
Fax Number	:	919-596-6147

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

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	02/03/2026

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