Active NPI
Lisa M Buckley, RD, LDN
- Registered Dietitian
- Concord, NC
National Provider Identifier
1649494196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 925612
- Practice address
- 200 Medical Park Dr
Suite 145 NE Oncology Associates
Concord, NC 28025-2982 - Phone
- (704) 783-1370
- Fax
- (704) 783-1389
- NPI assigned
- Apr 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 925612 | NC | Primary |
Addresses
Primary practice location
200 Medical Park Dr
Suite 145 NE Oncology Associates
Concord, NC 28025-2982
Mailing address
200 Medical Park Dr
Suite 145 NE Oncology Associates
Concord, NC 28025-2982
Phone (704) 783-1370
Other names 1
- Lisa M Deitch
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 925612 | NC | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649494196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 MEDICAL PARK DR",
"address_2": "SUITE 145 NE ONCOLOGY ASSOCIATES",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252982",
"telephone_number": "704-783-1370",
"fax_number": "704-783-1389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MEDICAL PARK DR",
"address_2": "SUITE 145 NE ONCOLOGY ASSOCIATES",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252982",
"telephone_number": "704-783-1370",
"fax_number": "704-783-1389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKLEY",
"first_name": "LISA",
"middle_name": "M",
"credential": "RD, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "925612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "DEITCH",
"middle_name": "M",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.