Healthcare Provider Details

I. General information

NPI: 1295730778
Provider Name (Legal Business Name): LISA M YORK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 K V RD
VICTORIA VA
23974-2624
US

IV. Provider business mailing address

1508 K V RD
VICTORIA VA
23974-2624
US

V. Phone/Fax

Practice location:
  • Phone: 434-696-2165
  • Fax:
Mailing address:
  • Phone: 434-696-2165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101236565
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: