Provider Demographics
NPI:1609975952
Name:IRVINE, LISA ANN (MD PHD FAAP)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:IRVINE
Suffix:
Gender:F
Credentials:MD PHD FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19152 COTON RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1662
Mailing Address - Country:US
Mailing Address - Phone:540-338-3320
Mailing Address - Fax:540-338-2280
Practice Address - Street 1:11930 DEMOCRACY DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5624
Practice Address - Country:US
Practice Address - Phone:202-660-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233858208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics