Provider Demographics
NPI:1447295795
Name:MCBRIDE, LISA ANNE (MD)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1247 SUNCREST TOWNE CENTRE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-599-8000
Mailing Address - Fax:304-599-8003
Practice Address - Street 1:9000 COOMBS FARM RD STE 102
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1150
Practice Address - Country:US
Practice Address - Phone:304-599-8000
Practice Address - Fax:304-599-8003
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22287208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006388Medicaid