MEDICARE: DR. LISA MICHELLE DEYERLE 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	0101234624	VA

General Provider Information

NPI Number	:	1669508735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MICHELLE DEYERLE M.D.

Provider Business Mailing Address
First Line	:	5020 GRANDIN ROAD EXT
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-2203
Country	:	US
Telephone Number	:	540-312-3552
Fax Number	:	949-676-1791

Provider Business Practice Location Address
First Line	:	5020 GRANDIN ROAD EXT
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-2203
Country	:	US
Telephone Number	:	540-312-3552
Fax Number	:	949-676-1791

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	03/09/2026

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