Provider Demographics
NPI:1942263819
Name:NOBLE, LISA SUZANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SUZANNE
Last Name:NOBLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1347
Mailing Address - Country:US
Mailing Address - Phone:304-723-6040
Mailing Address - Fax:304-723-6039
Practice Address - Street 1:651 COLLIERS WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5053
Practice Address - Country:US
Practice Address - Phone:304-797-6520
Practice Address - Fax:304-797-6525
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV18572080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1000194000Medicaid
OH2255456Medicaid
WV4238941Medicare PIN
OH2255456Medicaid