Provider Demographics
NPI:1497726079
Name:ALFORD, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:ALFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1069
Mailing Address - Country:US
Mailing Address - Phone:630-725-2730
Mailing Address - Fax:844-205-5691
Practice Address - Street 1:8201 16TH ST
Practice Address - Street 2:APT 309
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3240
Practice Address - Country:US
Practice Address - Phone:301-807-4055
Practice Address - Fax:877-284-8933
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0357872086S0129X
MDD00429312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00737670OtherRAILROAD MEDICARE
MD0977004 00Medicaid
DC001080ZBDDMedicare PIN
DCP00737670OtherRAILROAD MEDICARE
NY1N0321Medicare ID - Type Unspecified
NYG19165Medicare UPIN