Provider Demographics
NPI:1568467439
Name:CONAGHAN, LISA A (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:CONAGHAN
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 1:10330 MERIDIAN AVE N
Mailing Address - Street 2:STE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9463
Mailing Address - Country:US
Mailing Address - Phone:206-368-6644
Mailing Address - Fax:206-368-6645
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:STE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9463
Practice Address - Country:US
Practice Address - Phone:206-368-6644
Practice Address - Fax:206-368-6645
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1104660Medicaid
AB05944Medicare ID - Type Unspecified
G80945Medicare UPIN