Individual
LISA DEAFENBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1704 SIR WILLIAM OSLER DR, VIRGINIA BEACH, VA 23454-3003
(757) 481-4383
(757) 481-4611
Mailing address
1704 SIR WILLIAM OSLER DR, VIRGINIA BEACH, VA 23454-3003
(757) 481-4383
(757) 481-4611
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110001702
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00109464
MEDICARE RAILROAD
—
Enumeration date
08/30/2006
Last updated
08/03/2016
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