Provider Demographics
NPI:1003872888
Name:LIS, BARBARA D (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:D
Last Name:LIS
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 1:1501 SENTINEL DR STE 407
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4471
Mailing Address - Country:US
Mailing Address - Phone:757-276-7585
Mailing Address - Fax:877-485-8290
Practice Address - Street 1:1501 SENTINEL DR STE 407
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4471
Practice Address - Country:US
Practice Address - Phone:757-276-7585
Practice Address - Fax:877-485-8290
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5645174Medicaid
VA000559P95Medicare PIN
VA5645174Medicaid