Provider Demographics
NPI:1962445429
Name:STEPHENS, LISA D (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:D
Last Name:STEPHENS
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 1:1950 GLENN MITCHELL DR
Mailing Address - Street 2:STE 304
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0019
Mailing Address - Country:US
Mailing Address - Phone:757-507-0255
Mailing Address - Fax:
Practice Address - Street 1:1950 GLENN MITCHELL DR
Practice Address - Street 2:STE 304
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0019
Practice Address - Country:US
Practice Address - Phone:757-507-0255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226853208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
006702171OtherVA PREMIER
VI006702171Medicaid
22927925OtherVIRGINIA HEALTH NETWORK
229529252OtherUNITED HEALTH CARE
282142OtherMDIPA/MAMSI
541778786001OtherTRICARE
29851OtherOPTIMA
452258OtherANTHEM
NC89063N4Medicaid
VI006702171Medicaid