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NPI Code Detail

MEDICARE: LISA MICHELLE FORD M.D

MEDICARE: LISA MICHELLE FORD 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
1207Q00000XFamily Medicine PhysicianA78186CA
2207Q00000XFamily Medicine Physician0101249355VA
3207Q00000XFamily Medicine Physician2014-01731NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00621284OTHERCAMEDICARE RAIL ROAD

General Provider Information

NPI Number : 1881608248
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MICHELLE FORD M.D
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 704-316-3136
Fax Number :
Provider Business Practice Location Address
First Line : 7804 FAIRVIEW RD STE A
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-4999
Country : US
Telephone Number : 704-316-3136
Fax Number : 704-316-3140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 04/12/2023

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Directions to “ LISA MICHELLE FORD M.D” Practice Location

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