Provider Demographics
NPI:1881697662
Name:MCGREGOR, LISA M (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:MCGREGOR
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:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38552208000000X, 2080P0207X
PAMD4455532080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010178991Medicaid
PA102703290Medicaid
IN200512810AMedicaid
MO208410308Medicaid
KY64086705Medicaid
OH2567815Medicaid
MI104817903Medicaid
AR154465001Medicaid
OK200035500AMedicaid
LA1470929Medicaid
NJ0076074Medicaid
MT0147862Medicaid
MS04231771Medicaid
TX175316201Medicaid
ME422400000Medicaid
TN5440207Medicaid
PA102703290Medicaid
OH2567815Medicaid