Provider Demographics
NPI:1144415332
Name:JULIUS LISTER, M.D., SURGERY OF INFANTS AND CHILDREN, INC.
Entity Type:Organization
Organization Name:JULIUS LISTER, M.D., SURGERY OF INFANTS AND CHILDREN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-872-0616
Mailing Address - Street 1:61 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8264
Mailing Address - Country:US
Mailing Address - Phone:508-872-0616
Mailing Address - Fax:508-879-5511
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-872-0616
Practice Address - Fax:508-879-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27610174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty