Healthcare Provider Details

I. General information

NPI: 1134383128
Provider Name (Legal Business Name): LISA MARII COOKINGHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 ACC BLVD STE 300
RALEIGH NC
27617-8744
US

IV. Provider business mailing address

7920 ACC BLVD STE 300
RALEIGH NC
27617-8744
US

V. Phone/Fax

Practice location:
  • Phone: 919-908-0000
  • Fax: 919-596-6147
Mailing address:
  • Phone: 919-908-0000
  • Fax: 919-596-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number2024-00952
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD-40111
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number70191
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number83564
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: