MEDICARE: LISA MOLLOHAN REPASKY P.A.

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	363A00000X	Physician Assistant	0110840808	VA

General Provider Information

NPI Number	:	1952345456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MOLLOHAN REPASKY P.A.

Provider Business Mailing Address
First Line	:	3707 BRAMBLETON AVE STE 2
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3658
Country	:	US
Telephone Number	:	540-725-7800
Fax Number	:	540-989-6752

Provider Business Practice Location Address
First Line	:	3707 BRAMBLETON AVE STE 2
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3658
Country	:	US
Telephone Number	:	540-725-7800
Fax Number	:	540-989-6752

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/28/2021

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