Provider Demographics
NPI:1295747202
Name:GRUBB, LISA ANN (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:GRUBB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:DOBERSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2900 LAMB CIR
Mailing Address - Street 2:SUITE 380
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6344
Mailing Address - Country:US
Mailing Address - Phone:540-633-0523
Mailing Address - Fax:540-633-0526
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:SUITE 380
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-633-0523
Practice Address - Fax:540-633-0526
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001151363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540506332048OtherTRICARE/CHAMPUS
VA1295747202OtherOPTIMA HEALTH PLAN
VA1295747202OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1295747202OtherHUMANA MEDICARE
VA1295747202OtherINTOTAL
VA1295747202OtherMEDICAID QMB
VA1295747202OtherANTHEM MEDIGAP
VA1295747202OtherAETNA
VA1295747202OtherUMWA
VA371194700OtherBLACK LUNG
VAP00922434OtherRAILROAD MEDICARE
VA540506332048OtherTRICARE/CHAMPUS