Healthcare Provider Details

I. General information

NPI: 1831509942
Provider Name (Legal Business Name): LISA MARIE GRANT-MCDONALD DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE GRANT-MCDONALD DPM

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 GREENSPRING DR
STAFFORD VA
22554-1752
US

IV. Provider business mailing address

1340 CENTRAL PARK BLVD STE 100
FREDERICKSBURG VA
22401-4940
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-4602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301228
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006593
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: