Provider Demographics
NPI:1326157249
Name:DEAFENBAUGH, LISA (PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DEAFENBAUGH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1704 SIR WILLIAM OSLER DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3003
Mailing Address - Country:US
Mailing Address - Phone:757-481-4383
Mailing Address - Fax:757-481-4611
Practice Address - Street 1:1704 SIR WILLIAM OSLER DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3003
Practice Address - Country:US
Practice Address - Phone:757-481-4383
Practice Address - Fax:757-481-4611
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001702363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00109464OtherMEDICARE RAILROAD
VAC01592Medicare PIN
P00109464OtherMEDICARE RAILROAD