Healthcare Provider Details

I. General information

NPI: 1841427804
Provider Name (Legal Business Name): LISA ARSENAULT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 01/18/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9905 MEDICAL CENTER DR STE 200
ROCKVILLE MD
20850-6535
US

IV. Provider business mailing address

9905 MEDICAL CENTER DR STE 200
ROCKVILLE MD
20850-6535
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-6231
  • Fax:
Mailing address:
  • Phone: 301-424-6231
  • Fax: 301-294-4648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC0001231
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: