1467556043 NPI number — CENTER FOR HEALTH AND CANCER PREVENTION PC

Table of content: DR. LISA S. GREEN O.D. (NPI 1316966047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467556043 NPI number — CENTER FOR HEALTH AND CANCER PREVENTION PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR HEALTH AND CANCER PREVENTION PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467556043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 FIRST COLONIAL RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23454-2263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-412-4919
Provider Business Mailing Address Fax Number:
757-412-4898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 FIRST COLONIAL RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23454-2263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-412-4919
Provider Business Practice Location Address Fax Number:
757-412-4898
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERGER
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
757-412-4919

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101032987 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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