| Doctor Name: | LISA CSEH EDSALL |
| NPI Number: | 1194933861 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD, PHD |
| License Number: | 0101241020 |
| Business Practice Address: | 320a Charles H Dimmock Pkwy Suite 7 Colonial Heights, VA - 238342917 |
| Business Phone Number: | 8045267364 |
| Business Fax Number: | 8045267394 |
| Mailing Address: | 301 Concourse Blvd, Suite 190 GLEN ALLEN |
| State: | VA |
| Postal Code: | 230595643 |
| Phone Number: | 8045494030 |
| Fax Number: | 8045494032 |
| NPI Enumeration Date: | 05/18/2007 |
| NPI Last Update Date: | 03/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 0101241020 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |