Provider Demographics
NPI:1316212889
Name:HIMMELSTEIN, LISA RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RUTH
Last Name:HIMMELSTEIN
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 1:2515 LONDONDERRY RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-2332
Mailing Address - Country:US
Mailing Address - Phone:703-799-2587
Mailing Address - Fax:
Practice Address - Street 1:2515 LONDONDERRY RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22308-2332
Practice Address - Country:US
Practice Address - Phone:703-799-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043256207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology