Provider Demographics
NPI:1528243565
Name:LISA CAREY, DPM
Entity type:Organization
Organization Name:LISA CAREY, DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:571-223-0424
Mailing Address - Street 1:44135 WOODRIDGE PKWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1244
Mailing Address - Country:US
Mailing Address - Phone:571-223-0424
Mailing Address - Fax:571-223-0425
Practice Address - Street 1:44135 WOODRIDGE PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1244
Practice Address - Country:US
Practice Address - Phone:571-223-0424
Practice Address - Fax:571-223-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300853213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1871536995OtherINDIVIDUAL NPI
VA5129090OtherCIGNA
VA8972OtherCAREFIRST BC/BS
VA491988Y74OtherMEDICARE PIN DC
VA5331120OtherANTHEM BC/BS
VA1871536995OtherINDIVIDUAL NPI
VA5331120OtherANTHEM BC/BS
VA491988Y74OtherMEDICARE PIN DC