Provider Demographics
NPI:1134383128
Name:COOKINGHAM, LISA MARII (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARII
Last Name:COOKINGHAM
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 1:7920 ACC BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8744
Mailing Address - Country:US
Mailing Address - Phone:919-908-0000
Mailing Address - Fax:919-596-6147
Practice Address - Street 1:7920 ACC BLVD STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8744
Practice Address - Country:US
Practice Address - Phone:919-908-0000
Practice Address - Fax:919-596-6147
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-00952207VE0102X
IAMD-40111207VG0400X
AZ70191207V00000X
SC83564207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ70192OtherTRAINING PERMIT