Provider Demographics
NPI:1174579759
Name:HIGHTOW- WEIDMAN, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HIGHTOW- WEIDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MASON FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7030
Mailing Address - Country:US
Mailing Address - Phone:919-843-0033
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-8710
Practice Address - Country:US
Practice Address - Phone:919-843-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100244207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H35696Medicare UPIN
NC2021692BMedicare ID - Type Unspecified