Provider Demographics
NPI:1235109653
Name:MERRILL, LISA CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CHRISTINE
Last Name:MERRILL
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 1:100 SENTARA CIR
Mailing Address - Street 2:ROOM 2C
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5713
Mailing Address - Country:US
Mailing Address - Phone:757-984-7218
Mailing Address - Fax:757-984-7210
Practice Address - Street 1:100 SENTARA CIR
Practice Address - Street 2:ROOM 2C
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5713
Practice Address - Country:US
Practice Address - Phone:757-984-7218
Practice Address - Fax:757-984-7210
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084589207Q00000X
VA0101248071208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04782OtherPARAMOUNT INSURANCE
OH5191153OtherCIGNA INSURANCE
OH2574174Medicaid
OH000000367441OtherANTHEM INSURANCE
OH000000367441OtherANTHEM INSURANCE
OHI32212Medicare UPIN