Provider Demographics
NPI:1932256039
Name:LISA K FEULNER MD PHD PA
Entity Type:Organization
Organization Name:LISA K FEULNER MD PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FEULNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:410-569-7173
Mailing Address - Street 1:104 PLUMTREE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6095
Mailing Address - Country:US
Mailing Address - Phone:410-569-7173
Mailing Address - Fax:410-569-7123
Practice Address - Street 1:104 PLUMTREE RD STE 107
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6095
Practice Address - Country:US
Practice Address - Phone:410-569-7173
Practice Address - Fax:410-569-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055167174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1974041Medicaid
MD182503800Medicaid