Provider Demographics
NPI:1093789364
Name:DUGGAN, LISA A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:DUGGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-1460
Mailing Address - Country:US
Mailing Address - Phone:540-786-2100
Mailing Address - Fax:540-786-0677
Practice Address - Street 1:16463 DAHLGREN RD
Practice Address - Street 2:
Practice Address - City:DAHLGREN
Practice Address - State:VA
Practice Address - Zip Code:22448
Practice Address - Country:US
Practice Address - Phone:540-644-9505
Practice Address - Fax:540-644-9508
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002252363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093789364Medicaid
VA1093789364Medicaid