Provider Demographics
NPI:1881648327
Name:RAHANGDALE, LISA (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RAHANGDALE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-2539
Mailing Address - Country:US
Mailing Address - Phone:919-843-6301
Mailing Address - Fax:919-966-6356
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-843-6301
Practice Address - Fax:919-966-6356
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00800207V00000X
CAA87044207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A870440Medicaid
I11405Medicare UPIN
CA00A870440Medicare ID - Type Unspecified