Park, Lisa L

Park, Lisa L is an individual health care provider with primary practice located at 4400 University Dr Student Union Building 1, Room 2300, Fairfax VA 22030-4422. She recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as her primary health care specialty. Park, Lisa L can be contacted via phone (703) 993-2831.

Contact Information

Primary practice address
4400 University Dr Student Union Building 1, Room 2300 Fairfax VA 22030-4422
Phone: (703) 993-2831
Fax: (703) 993-4365
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 0101250887 Virginia
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 25MA08646300 New Jersey

Profile Details

NPI number 1699982868
LBN Legal business name Park, Lisa L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2007
Last updated Jan 11th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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