Provider Demographics
NPI:1083726194
Name:SWEENEY, LISA DOMAL (MD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DOMAL
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 ROCHE BROS WAY STE 220
Mailing Address - Street 2:ONE WASHINGTON ST
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1000
Mailing Address - Country:US
Mailing Address - Phone:508-230-0155
Mailing Address - Fax:508-230-0145
Practice Address - Street 1:15 ROCHE BROS WAY STE 220
Practice Address - Street 2:ONE WASHINGTON ST
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1000
Practice Address - Country:US
Practice Address - Phone:508-230-0155
Practice Address - Fax:508-230-0145
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA150105207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3189911Medicaid
MAJ19779OtherBCBS
MA711529OtherHPHC
A23277Medicare UPIN
MA3189911Medicaid