Healthcare Provider Details

I. General information

NPI: 1235109653
Provider Name (Legal Business Name): LISA CHRISTINE MERRILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SENTARA CIR ROOM 2C
WILLIAMSBURG VA
23188-5713
US

IV. Provider business mailing address

100 SENTARA CIR ROOM 2C
WILLIAMSBURG VA
23188-5713
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-7218
  • Fax: 757-984-7210
Mailing address:
  • Phone: 757-984-7218
  • Fax: 757-984-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-084589
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101248071
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101248071
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: