Provider Demographics
NPI:1770192825
Name:RARICK, LISA DALE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DALE
Last Name:RARICK
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 1:8195 WINDWARD KEY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3123
Mailing Address - Country:US
Mailing Address - Phone:301-219-9505
Mailing Address - Fax:
Practice Address - Street 1:8195 WINDWARD KEY DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3123
Practice Address - Country:US
Practice Address - Phone:301-219-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060729207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology