Provider Demographics
NPI:1063401362
Name:FEULNER, LISA K (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:FEULNER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PLUMTREE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6095
Mailing Address - Country:US
Mailing Address - Phone:410-569-7173
Mailing Address - Fax:410-569-7123
Practice Address - Street 1:104 PLUMTREE RD STE 107
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6095
Practice Address - Country:US
Practice Address - Phone:410-569-7173
Practice Address - Fax:410-569-7123
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055167174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD182503800Medicaid
H02789Medicare UPIN
MD182503800Medicaid