Healthcare Provider Details

I. General information

NPI: 1962445429
Provider Name (Legal Business Name): LISA DAWN STEPHENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 GLENN MITCHELL DR STE 310
VIRGINIA BEACH VA
23456-0019
US

IV. Provider business mailing address

1950 GLENN MITCHELL DR STE 310
VIRGINIA BEACH VA
23456-0019
US

V. Phone/Fax

Practice location:
  • Phone: 757-507-0255
  • Fax:
Mailing address:
  • Phone: 757-507-0255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101226853
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: