Provider Demographics
NPI:1275770679
Name:BECKINELLA, LISA ANN (DPM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BECKINELLA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8577 SUDLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3860
Mailing Address - Country:US
Mailing Address - Phone:703-368-7166
Mailing Address - Fax:703-368-5103
Practice Address - Street 1:8577 SUDLEY RD STE A
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3860
Practice Address - Country:US
Practice Address - Phone:703-368-7166
Practice Address - Fax:703-368-5103
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103049843213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA186715OtherMEDICARE GROUP
VACC5940OtherRAILROAD MEDICARE GROUP
VAC01127OtherMEDICARE GROUP
VAC02868OtherMEDICARE GROUP
VA186715OtherMEDICARE GROUP