Provider Demographics
NPI:1578700118
Name:VERKA, LISENA G (MD)
Entity Type:Individual
Prefix:
First Name:LISENA
Middle Name:G
Last Name:VERKA
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 1:5832 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6290
Mailing Address - Country:US
Mailing Address - Phone:919-544-6644
Mailing Address - Fax:
Practice Address - Street 1:5832 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 113
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6290
Practice Address - Country:US
Practice Address - Phone:919-544-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913522Medicaid
NC2023419Medicare PIN