Provider Demographics
NPI:1457671935
Name:REED, LISA NIEDERGESES (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NIEDERGESES
Last Name:REED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:NIEDERGESES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:119 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2868
Mailing Address - Country:US
Mailing Address - Phone:828-257-4725
Mailing Address - Fax:828-232-2953
Practice Address - Street 1:218 ELKWOOD AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804
Practice Address - Country:US
Practice Address - Phone:828-257-4747
Practice Address - Fax:828-257-4763
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457671935Medicaid
NC1457671935Medicaid