Healthcare Provider Details

I. General information

NPI: 1013932474
Provider Name (Legal Business Name): LISA LYNN PIKE-BUCHANAN SC.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14225 NEWBROOK DR
CHANTILLY VA
20151-2228
US

IV. Provider business mailing address

PO BOX 460
LINDEN VA
22642-0460
US

V. Phone/Fax

Practice location:
  • Phone: 703-802-7069
  • Fax:
Mailing address:
  • Phone: 540-295-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number2002266
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: