Healthcare Provider Details

I. General information

NPI: 1447295795
Provider Name (Legal Business Name): LISA ANNE MCBRIDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANNE WOOD M.D.

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 JEFFERSON ST N STE 200
LEWISBURG WV
24901-7702
US

IV. Provider business mailing address

176 MEDICAL CENTER DR
RAINELLE WV
25962-1064
US

V. Phone/Fax

Practice location:
  • Phone: 681-484-7042
  • Fax: 304-520-4029
Mailing address:
  • Phone: 304-438-6188
  • Fax: 304-438-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22287
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: