Healthcare Provider Details

I. General information

NPI: 1093880379
Provider Name (Legal Business Name): LISA SCHILLER LULL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA GAIL SCHILLER MD

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

8001 FORBES PL STE 103
SPRINGFIELD VA
22151-2205
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3000
  • Fax:
Mailing address:
  • Phone: 703-824-3210
  • Fax: 703-321-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28980
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number00026757
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0055972
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number44917
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0066919
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10394A
License Number StateWY
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number27845
License Number StateWV
# 8
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101263277
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: