Provider Demographics
NPI:1376544486
Name:NG, TIK KA LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:TIK KA
Middle Name:LISA
Last Name:NG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4000 OLNEY LAYTONSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1802
Mailing Address - Country:US
Mailing Address - Phone:301-774-2506
Mailing Address - Fax:301-774-3734
Practice Address - Street 1:4000 OLNEY LAYTONSVILLE RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1802
Practice Address - Country:US
Practice Address - Phone:301-774-2506
Practice Address - Fax:301-774-3734
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7605-0062OtherCAREFIRST BLUECHOICE
MD8120765OtherMAMSI PRIMARY CARE
MD0989033OtherCIGNA PIN
MD2097791OtherUHC PROVIDER NUMBER
MD2120765OtherMAMSI SPECIALIST
MDP16105OtherCAREFIRST MPOS
MDD0055931OtherMHIP PROVIDER ID
MD607673-03OtherCAREFIRST MD RENDERING
MD125716OtherJHHC PROVIDER NUMBER
MD2619428OtherAETNA CAPITATED
MD7104241OtherAETNA FEE FOR SERVICE
MD2120765OtherMAMSI SPECIALIST
MD607673-03OtherCAREFIRST MD RENDERING