Provider Demographics
NPI:1831239961
Name:MCLEOD, LISA F
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:F
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 ASHBY ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2902
Mailing Address - Country:US
Mailing Address - Phone:703-837-1138
Mailing Address - Fax:
Practice Address - Street 1:209 ASHBY ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2902
Practice Address - Country:US
Practice Address - Phone:703-837-1138
Practice Address - Fax:703-837-1138
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA30546-01171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1031150001Medicare PIN