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General NPI Number Information
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NPI Number | 1265881676
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Entity Type | Individual
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Provider Name | LISA MICHELLE TOM M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 5454 WISCONSIN AVE STE 950
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City | CHEVY CHASE
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State | MD
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Zip | 20815-6912
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Country | US
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Telephone | 301-657-5700
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Fax | 301-654-9132
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Provider Business Mailing Address
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Address Line | 2 PILLSBURY ST STE 100
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City | CONCORD
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State | NH
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Zip | 03301-3549
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Country | US
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Telephone | 603-224-2020
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Fax | 603-228-7061
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D0095596
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME145348
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | 21488
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD210002800
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | MD210002800
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License Number State | DC
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Taxonomy #6
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | D0095596
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License Number State | MD
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