Provider Demographics
NPI:1104000728
Name:LISA MCLEOD
Entity Type:Organization
Organization Name:LISA MCLEOD
Other - Org Name:LISA MCLEOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:FRANCENE
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-837-1138
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:703-837-1138
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA30546-01332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1031150001Medicare NSC