Provider Demographics
NPI:1881973691
Name:LISA ABERNETHY CHRISTMAN, M.D., DERMATOLOGY, P.A.
Entity type:Organization
Organization Name:LISA ABERNETHY CHRISTMAN, M.D., DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ABERNETHY
Authorized Official - Last Name:CHRISTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-782-2735
Mailing Address - Street 1:3900 BROWNING PL STE 202
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6508
Mailing Address - Country:US
Mailing Address - Phone:919-782-2735
Mailing Address - Fax:919-782-2839
Practice Address - Street 1:3900 BROWNING PL STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6508
Practice Address - Country:US
Practice Address - Phone:919-782-2735
Practice Address - Fax:919-782-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400184207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2200880AOtherMEDICARE PTAN
NC1144214487Medicare PIN