Basic Information
| Provider Information | |||||||||
| NPI: | 1578700118 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERKA | ||||||||
| FirstName: | LISENA | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5832 FAYETTEVILLE RD | ||||||||
| Address2: | SUITE 113 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277136290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195446644 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5832 FAYETTEVILLE RD | ||||||||
| Address2: | SUITE 113 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277136290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195446644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 03/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2008-01777 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8913522 | 05 | NC | MEDICAID |