Provider Demographics
NPI:1487635181
Name:CASH, LISA RENE OTTO (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENE OTTO
Last Name:CASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:408 16TH STREET
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:VA
Practice Address - Zip Code:23181
Practice Address - Country:US
Practice Address - Phone:804-843-3131
Practice Address - Fax:804-843-3222
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA185403OtherANTHEM
VA010210224Medicaid
P00319511OtherRR/MEDICARE
VAH81279Medicare UPIN
VA009248T78Medicare PIN