Basic Information
| Provider Information | |||||||||
| NPI: | 1598826299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIZOTTE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 ABRAHAM FLEXNER WAY STE 1200 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405645791 | ||||||||
| FaxNumber: | 5025838389 | ||||||||
| Practice Location | |||||||||
| Address1: | 2006 HEALTH CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228018679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406895555 | ||||||||
| FaxNumber: | 5406895556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 06/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110002429 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | ML0882325 | 01 | DEA | OTHER | 0110002429 | 01 | VA | PA LICENSE | OTHER | 1027307 | 01 | NCCPA CERTIFICATION # | OTHER | 1598826299 | 05 | VA | MEDICAID |