Healthcare Provider Details

I. General information

NPI: 1235871047
Provider Name (Legal Business Name): MADISON LISA LORD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWNS STANTON SUITE 5A43
NEWARK DE
19718-2200
US

IV. Provider business mailing address

214 WHITE HORSE PIKE APT C
HADDON HEIGHTS NJ
08035-2009
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-0188
  • Fax: 302-733-5640
Mailing address:
  • Phone: 954-901-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC2-0024744
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: