Provider Demographics
NPI:1558500900
Name:HARRIS, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HARRIS
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 1:2501 MARSHALL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:877-991-9049
Practice Address - Street 1:2501 MARSHALL AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4636
Practice Address - Country:US
Practice Address - Phone:757-247-3910
Practice Address - Fax:877-991-9049
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010510612083A0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine