Provider Demographics
NPI:1740267178
Name:BLEDSOE, LISA ANN (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1021 DARRINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8158
Mailing Address - Country:US
Mailing Address - Phone:198-523-9999
Mailing Address - Fax:919-378-9114
Practice Address - Street 1:2839 WENDELL BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591
Practice Address - Country:US
Practice Address - Phone:919-365-7272
Practice Address - Fax:919-822-0035
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2023-00218207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740267178Medicaid
Q0087849OtherSHO
IN000000081524OtherANTHEM
080081718OtherMEDICARE RR
IN000000603908OtherANTHEM
316780743OtherTRICARE
NC1740267178Medicaid
316780743OtherTRICARE