Healthcare Provider Details

I. General information

NPI: 1871536995
Provider Name (Legal Business Name): LISA CAREY D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44135 WOODRIDGE PKWY 180
LEESBURG VA
20176-1244
US

IV. Provider business mailing address

44135 WOODRIDGE PKWY 180
LEESBURG VA
20176-1244
US

V. Phone/Fax

Practice location:
  • Phone: 571-223-0424
  • Fax: 571-223-0425
Mailing address:
  • Phone: 571-223-0424
  • Fax: 571-223-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0103300853
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: