Provider Demographics
NPI:1871536995
Name:CAREY, LISA (DPM)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:CAREY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44135 WOODRIDGE PKWY
Mailing Address - Street 2:180
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 2:180
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300853213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA228919OtherSOUTHERN HEALTH
VA279224OtherANTHEM
VAJ147OtherCARE FIRST
VA6182740001Medicare NSC
VA228919OtherSOUTHERN HEALTH
VAJ147OtherCARE FIRST
VAVAA101562Medicare PIN