Healthcare Provider Details

I. General information

NPI: 1700906922
Provider Name (Legal Business Name): JOSEPH LIZOTTE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6112 SAINT GILES ST
RALEIGH NC
27612-7043
US

IV. Provider business mailing address

6112 SAINT GILES ST
RALEIGH NC
27612-7043
US

V. Phone/Fax

Practice location:
  • Phone: 919-893-4465
  • Fax: 919-689-5350
Mailing address:
  • Phone: 919-893-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08405
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: