Provider Demographics
NPI:1508086182
Name:GENAO, LIZA ISABEL (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:ISABEL
Last Name:GENAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:ISABEL
Other - Last Name:GENAO GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 VILLAGE CIRCLE WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6126
Mailing Address - Country:US
Mailing Address - Phone:347-622-9471
Mailing Address - Fax:
Practice Address - Street 1:40 DUKE MEDICINE CIR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4000
Practice Address - Country:US
Practice Address - Phone:919-660-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50824207R00000X
NC2009-01514207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110012153Medicare PIN