Provider Demographics
NPI:1215966213
Name:LISACKAUFMAN,MD,ALLENT GREENLEE,MD,AND ELIZABETHPWHEATONMD,PC
Entity type:Organization
Organization Name:LISACKAUFMAN,MD,ALLENT GREENLEE,MD,AND ELIZABETHPWHEATONMD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-833-7051
Mailing Address - Street 1:PO BOX 3160
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0803
Mailing Address - Country:US
Mailing Address - Phone:978-474-8885
Mailing Address - Fax:978-474-8845
Practice Address - Street 1:1850 M ST NW STE 230
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5812
Practice Address - Country:US
Practice Address - Phone:202-833-7051
Practice Address - Fax:202-833-7056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCDF7177OtherMEDICARE RR
DC031907Medicare PIN