Provider Demographics
NPI:1295730778
Name:YORK, LISA M (MD)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:YORK
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 1:1508 K V RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23974-2624
Mailing Address - Country:US
Mailing Address - Phone:434-696-2165
Mailing Address - Fax:
Practice Address - Street 1:1508 K V RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:VA
Practice Address - Zip Code:23974-2624
Practice Address - Country:US
Practice Address - Phone:434-696-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010092388Medicaid
VA224189800OtherDOL
VAP00236446OtherRR MEDICARE KB
VA1295730778Medicaid
VA144746OtherBCBS #
VA189201OtherBCBS #
VA52807OtherCARENET
VA7181719OtherAETNA
VA91404OtherOPTIMA
VAD9947OtherMEDCOST
VA010103401OtherVA PREMIER KB
VA010103584Medicaid
VAP00253131OtherRR MEDICARE
VA52392OtherCARENET KB
VA5903138OtherNC MEDICAID
VA7407427OtherCIGNA
VA010103401Medicaid
VA144745OtherBCBS #
VA92825OtherOPTIMA KB
VAD9948OtherMEDCOST
VA010092388OtherVA PREMIER
VA1295730778OtherNPI
VA299406OtherSOUTHERN HEALTH
VA299407OtherSOUTHERN HEALTH KB
VA299421OtherSOUTHERN HEALTH KB
VAD9949OtherMEDCOST
VA144745OtherBCBS #
VA299407OtherSOUTHERN HEALTH KB
VA7181719OtherAETNA
VAD9948OtherMEDCOST
VA92825OtherOPTIMA KB
VA010103401Medicaid
VA00Y193C04Medicare PIN
VA005325K59Medicare PIN