Provider Demographics
NPI:1447235304
Name:NEWSOME, LISA T (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:T
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:TESTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5214
Mailing Address - Country:US
Mailing Address - Phone:914-637-3510
Mailing Address - Fax:914-819-0061
Practice Address - Street 1:1300 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2148
Practice Address - Country:US
Practice Address - Phone:919-832-3432
Practice Address - Fax:919-832-3305
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94010681223G0001X, 207L00000X, 1223D0004X
IL036167627207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No1223G0001XDental ProvidersDentistGeneral Practice
No1223D0004XDental ProvidersDentistDentist Anesthesiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8982439Medicaid
NC2212980DMedicare PIN
NC8982439Medicaid