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General NPI Number Information
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NPI Number | 1720071194
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Entity Type | Individual
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Provider Name | LISA R NEWELL D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 267 STAUNTON AVE
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25303-2503
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Country | US
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Telephone | 304-768-0321
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Fax | 833-972-5595
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Provider Business Mailing Address
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Address Line | 267 STAUNTON AVE
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25303-2503
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Country | US
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Telephone | 304-768-0321
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Fax | 833-972-5595
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1820
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License Number State | WV
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