1740263177 NPI number — LISA C MUASHER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740263177 NPI number — LISA C MUASHER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MUASHER

Provider First Name:

LISA

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1740263177

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5213 S ALSTON AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DURHAM

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

27713-4430

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

919-684-8111

Provider Business Mailing Address Fax Number:

919-620-4291

Provider First Line Business Practice Location Address:

2101 ERWIN ROAD

Provider Second Line Business Practice Location Address:

CLINIC A

Provider Business Practice Location Address City Name:

DURHAM

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

27710-0001

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

919-684-8111

Provider Business Practice Location Address Fax Number:

919-620-4921

Provider Enumeration Date:

11/21/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  0101054677 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207V00000X , with the licence number: 2012-00021 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0703329 . This is a "UNHC" identifier . This identifiers is of the category "OTHER".
• Identifier: 297917 . This is a "MDIPA OPTIMUM" identifier . This identifiers is of the category "OTHER".
• Identifier: 3121905 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 34300008 . This is a "BCBS OF DC" identifier . This identifiers is of the category "OTHER".
• Identifier: 540894297 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
• Identifier: 5428771 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 297917 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 502422 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 540894297 . This is a "MAILHANDLERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 540894297 . This is a "GW ONE HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 7650865002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 383841 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 6210074 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".