Radebaugh, Lisa Carroll

Radebaugh, Lisa Carroll is an individual health care provider with primary practice located at 10753 Falls Rd Pavilion Ii Suite 415, Lutherville MD 21093-2967. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Radebaugh, Lisa Carroll can be contacted via phone (410) 583-2970.

Contact Information

Primary practice address
10753 Falls Rd Pavilion Ii Suite 415 Lutherville MD 21093-2967
Phone: (410) 583-2970
Fax: (410) 583-2980
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X R080294 Maryland

Profile Details

NPI number 1588688345
LBN Legal business name Radebaugh, Lisa Carroll
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2006
Last updated Jul 8th, 2007 - about 17 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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Identifiers

StateTypeNumberIssuer
All States NPI 1588688345 NPPES
Maryland Other 53410801 BLUE SHIELD
Maryland MEDICAID 972003100 BLUE SHIELD
Maryland Other 242566 BLUE SHIELD
Maryland Other 0092 BLUE SHIELD

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