Provider Demographics
NPI:1710955075
Name:SPEIGHT, LISA W (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:W
Last Name:SPEIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5009 HONEYGO CENTER DR
Mailing Address - Street 2:SUITE 216
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9815
Mailing Address - Country:US
Mailing Address - Phone:410-256-5858
Mailing Address - Fax:410-529-2431
Practice Address - Street 1:5009 HONEYGO CENTER DR
Practice Address - Street 2:SUITE 216
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9815
Practice Address - Country:US
Practice Address - Phone:410-256-5858
Practice Address - Fax:410-529-2431
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD47920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD089L 116NMedicare ID - Type Unspecified
G14088Medicare UPIN