Provider Demographics
NPI:1003872888
Name:LIS, BARBARA D (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:D
Last Name:LIS
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 1:633 BATTLEFIELD BLVD S
Mailing Address - Street 2:STE 300
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4800
Mailing Address - Country:US
Mailing Address - Phone:757-233-4700
Mailing Address - Fax:757-233-4701
Practice Address - Street 1:1239 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7103
Practice Address - Country:US
Practice Address - Phone:757-549-9935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5645174Medicaid
VA000559P95Medicare PIN
VA5645174Medicaid