Provider Demographics
NPI:1497962815
Name:MOTAVALLI, LISA S (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:S
Last Name:MOTAVALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 PLAINSBORO RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1915
Mailing Address - Country:US
Mailing Address - Phone:609-853-7272
Mailing Address - Fax:609-853-7271
Practice Address - Street 1:5 PLAINSBORO RD STE 300
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1915
Practice Address - Country:US
Practice Address - Phone:609-853-7272
Practice Address - Fax:609-853-7271
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07506200207RC0000X
FLME89086207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease