Individual
DARREN S LISSE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1850 TOWN CENTER PKWY, RESTON HOSPITAL CENTER, RESTON, VA 20190-3219
(703) 689-9037
(703) 689-9109
Mailing address
1300 PICCARD DR, SUITE 202, ROCKVILLE, MD 20850-4303
(301) 921-7900
(301) 921-7915
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101033354
VA
207P00000X
Emergency Medicine Physician
D0036068
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110
CAREFIRST
—
Enumeration date
10/17/2005
Last updated
07/08/2007
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