MEDICARE: DR. LISA RAINEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	D0055310	MD
2	208000000X	Pediatrics Physician	0101222832	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	217436	OTHER	VA	ANTHEM PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174544399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA RAINEY M.D.

Provider Business Mailing Address
First Line	:	205 S WHITING ST STE 200
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-3693
Country	:	US
Telephone Number	:	703-823-7400
Fax Number	:	703-823-5814

Provider Business Practice Location Address
First Line	:	205 S WHITING ST STE 205
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-3632
Country	:	US
Telephone Number	:	703-823-7400
Fax Number	:	703-823-5814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/19/2024

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