Provider Demographics
NPI:1881608248
Name:FORD, LISA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:SILVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-3136
Mailing Address - Fax:
Practice Address - Street 1:7804 FAIRVIEW RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4999
Practice Address - Country:US
Practice Address - Phone:704-316-3136
Practice Address - Fax:704-316-3140
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78186207Q00000X
VA0101249355207Q00000X
NC2014-01731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00621284OtherMEDICARE RAIL ROAD
VAVV3957AMedicare PIN
CAP00621284OtherMEDICARE RAIL ROAD