Provider Demographics
NPI:1750508131
Name:LISHCHYNSKY, MICHAEL ANDREW (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:LISHCHYNSKY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:5511 RAEFORD RD
Mailing Address - Street 2:STE 150
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2058
Mailing Address - Country:US
Mailing Address - Phone:910-764-1520
Mailing Address - Fax:910-424-6767
Practice Address - Street 1:5511 RAEFORD RD STE 150
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3049
Practice Address - Country:US
Practice Address - Phone:910-630-5000
Practice Address - Fax:910-424-6767
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC101919363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant