Healthcare Provider Details

I. General information

NPI: 1972946549
Provider Name (Legal Business Name): LISBI DEL VALLE RIVAS RAMIREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 ROCKLEDGE DR STE 4100
BETHESDA MD
20817-7847
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 240-762-5130
  • Fax: 410-367-2751
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD93865
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: