Provider Demographics
NPI:1811937550
Name:RAINEY, LISA M (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:RAINEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 COMMERCE AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9128
Mailing Address - Country:US
Mailing Address - Phone:717-240-1322
Mailing Address - Fax:717-240-0382
Practice Address - Street 1:215 LEDGE LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1960
Practice Address - Country:US
Practice Address - Phone:570-474-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004232L207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000626921Medicaid
10388095OtherCAQH
PA000626921Medicaid
PA000626921Medicaid