Provider Demographics
NPI:1346220290
Name:WEST, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:WEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:OLENIK WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3738 WINTERFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-9236
Mailing Address - Country:US
Mailing Address - Phone:804-378-9378
Mailing Address - Fax:804-378-9379
Practice Address - Street 1:3738 WINTERFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-9236
Practice Address - Country:US
Practice Address - Phone:804-378-9378
Practice Address - Fax:804-378-9379
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053220207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000137218904OtherUNITED
VA006205445Medicaid
226113OtherANTHEM
34350OtherOPTIMA HEALTH
541941044002OtherTRICARE
160049261OtherRR MEDICARE
6205445OtherVA PREMIER
0970529OtherAETNA USHEALTH
328075OtherMAMSI
34350OtherSENTARA
94542OtherSOUTHERN HEALTH
VA8785535OtherCIGNA
11943OtherCARENET
0000137218904OtherUNITED
VA8785535OtherCIGNA