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General NPI Number Information
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NPI Number | 1265639892
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Entity Type | Organization
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Legal Business Name | LISA KING MD LLC
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 10514 WAKEMAN DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-8040
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Country | US
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Telephone | 540-785-9500
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Fax | 866-601-0609
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Provider Business Mailing Address
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Address Line | 10514 WAKEMAN DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-8040
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Country | US
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Telephone | 540-785-9500
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Fax | 866-601-0609
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. LISA KING
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Credential | MD
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Telephone | 540-785-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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