Provider Demographics
NPI:1205083060
Name:BUCKINGHAM, LISA CAROLINE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:CAROLINE
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10800 PARKSIDE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1922
Mailing Address - Country:US
Mailing Address - Phone:865-218-6660
Mailing Address - Fax:865-218-6661
Practice Address - Street 1:10800 PARKSIDE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1922
Practice Address - Country:US
Practice Address - Phone:865-218-6660
Practice Address - Fax:865-218-6661
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD47943207V00000X
NC2010-01108207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology