Provider Demographics
NPI:1902960503
Name:LAWSON, LISA J (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:LAWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-5242
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902960503OtherMULTIPLAN
VA1902960503OtherTRICARE/CHAMPUS
VA1902960503OtherVIRGINIA HEALTH NETWORK
VA1902960503OtherCIGNA
VA1902960503OtherCOVENTRY HEALTH CARE
VA1902960503OtherANTHEM BC/BS
VA1902960503OtherAETNA
VA1902960503OtherUSA MANAGED CARE
VA1902960503OtherCORVEL
VA1902960503OtherVIRGINIA PREMIER HEALTH PLAN
VA1902960503Medicaid
VA1902960503OtherOPTIMA HEALTH
VA1902960503OtherUNITED HEALTHCARE
NC1902960503Medicaid
VA1902960503OtherUSA MANAGED CARE
VA1902960503OtherTRICARE/CHAMPUS
VAP01709430Medicare PIN