Healthcare Provider Details

I. General information

NPI: 1720042518
Provider Name (Legal Business Name): LISA M SKINNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA M. BREEDING MD

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660A S MAIN ST
MADISON WV
25130-1245
US

IV. Provider business mailing address

701 MADISON AVE
MADISON WV
25130-1699
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-1230
  • Fax: 304-606-6135
Mailing address:
  • Phone: 304-369-1230
  • Fax: 304-369-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number18105
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: