MEDICARE: LISA A CONAGHAN 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	207V00000X	Obstetrics & Gynecology Physician	MD00036600	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568467439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA A CONAGHAN MD

Provider Business Mailing Address
First Line	:	10330 MERIDIAN AVE N
Second Line	:	STE 300
City	:	SEATTLE
State	:	WA
Zip	:	98133-9463
Country	:	US
Telephone Number	:	206-368-6644
Fax Number	:	206-368-6645

Provider Business Practice Location Address
First Line	:	10330 MERIDIAN AVE N
Second Line	:	STE 300
City	:	SEATTLE
State	:	WA
Zip	:	98133-9463
Country	:	US
Telephone Number	:	206-368-6644
Fax Number	:	206-368-6645

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/12/2019

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