Provider Demographics
NPI:1881182087
Name:BISWAS, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BISWAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E 7TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-4398
Mailing Address - Country:US
Mailing Address - Phone:704-998-0983
Mailing Address - Fax:704-230-0066
Practice Address - Street 1:2600 E 7TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4398
Practice Address - Country:US
Practice Address - Phone:704-998-0983
Practice Address - Fax:704-230-0066
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-00546208000000X, 207K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program