Healthcare Provider Details
I. General information
NPI: 1881697662
Provider Name (Legal Business Name): LISA M MCGREGOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/24/2005
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
500 UNIVERSITY DR
HERSHEY PA
17033-2360
US
IV. Provider business mailing address
PO BOX 858 MC A410
HERSHEY PA
17033-0858
US
V. Phone/Fax
- Phone: 717-531-6012
- Fax:
- Phone: 800-243-1455
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 38552 |
| License Number State | TN |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080P0207X |
| Taxonomy | Pediatric Hematology & Oncology Physician |
| License Number | 38552 |
| License Number State | TN |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2080P0207X |
| Taxonomy | Pediatric Hematology & Oncology Physician |
| License Number | MD445553 |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 010178991 |
| Identifier Type | MEDICAID |
| Identifier State | VA |
| Identifier Issuer | |
| # 2 | |
| Identifier | 102703290 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 3 | |
| Identifier | 200512810A |
| Identifier Type | MEDICAID |
| Identifier State | IN |
| Identifier Issuer | |
| # 4 | |
| Identifier | 208410308 |
| Identifier Type | MEDICAID |
| Identifier State | MO |
| Identifier Issuer | |
| # 5 | |
| Identifier | 64086705 |
| Identifier Type | MEDICAID |
| Identifier State | KY |
| Identifier Issuer | |
| # 6 | |
| Identifier | 2567815 |
| Identifier Type | MEDICAID |
| Identifier State | OH |
| Identifier Issuer | |
| # 7 | |
| Identifier | 104817903 |
| Identifier Type | MEDICAID |
| Identifier State | MI |
| Identifier Issuer | |
| # 8 | |
| Identifier | 154465001 |
| Identifier Type | MEDICAID |
| Identifier State | AR |
| Identifier Issuer | |
| # 9 | |
| Identifier | 200035500A |
| Identifier Type | MEDICAID |
| Identifier State | OK |
| Identifier Issuer | |
| # 10 | |
| Identifier | 1470929 |
| Identifier Type | MEDICAID |
| Identifier State | LA |
| Identifier Issuer | |
| # 11 | |
| Identifier | 0076074 |
| Identifier Type | MEDICAID |
| Identifier State | NJ |
| Identifier Issuer | |
| # 12 | |
| Identifier | 0147862 |
| Identifier Type | MEDICAID |
| Identifier State | MT |
| Identifier Issuer | |
| # 13 | |
| Identifier | 04231771 |
| Identifier Type | MEDICAID |
| Identifier State | MS |
| Identifier Issuer | |
| # 14 | |
| Identifier | 175316201 |
| Identifier Type | MEDICAID |
| Identifier State | TX |
| Identifier Issuer | |
| # 15 | |
| Identifier | 422400000 |
| Identifier Type | MEDICAID |
| Identifier State | ME |
| Identifier Issuer | |
| # 16 | |
| Identifier | 5440207 |
| Identifier Type | MEDICAID |
| Identifier State | TN |
| Identifier Issuer | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
