Provider Demographics
NPI:1093751422
Name:HARTMAN, LISA MCAVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MCAVEY
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:940 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2601
Practice Address - Country:US
Practice Address - Phone:919-942-5123
Practice Address - Fax:919-942-5730
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9801382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912611Medicaid
NC12611OtherBLUE CROSS/BLUE SHIELD
NC8912611Medicaid
NC2281081DMedicare PIN