Individual
LISA RENEE DAVID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-4171
(336) 716-8759
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-0238
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
9400459
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2005471000
—
WV
01
—
27161
BCBS
NC
01
—
4575678
AETNA
NC
05
—
6900615
—
VA
01
—
8440
PARTNERS
NC
05
—
8927161
—
NC
01
—
97072
MEDCOST
NC
05
—
Q0045A
—
SC
Enumeration date
12/16/2005
Last updated
03/29/2022
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