MEDICARE: LISA CHRISTINE MERRILL 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	207Q00000X	Family Medicine Physician	35-084589	OH
2	208M00000X	Hospitalist Physician	0101248071	VA
3	207R00000X	Internal Medicine Physician	0101248071	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04782	OTHER	OH	PARAMOUNT INSURANCE
2	5191153	OTHER	OH	CIGNA INSURANCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000367441	OTHER	OH	ANTHEM INSURANCE

General Provider Information

NPI Number	:	1235109653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CHRISTINE MERRILL M.D.

Provider Business Mailing Address
First Line	:	100 SENTARA CIR
Second Line	:	ROOM 2C
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5713
Country	:	US
Telephone Number	:	757-984-7218
Fax Number	:	757-984-7210

Provider Business Practice Location Address
First Line	:	100 SENTARA CIR
Second Line	:	ROOM 2C
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5713
Country	:	US
Telephone Number	:	757-984-7218
Fax Number	:	757-984-7210

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	12/04/2023

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