Provider Demographics
NPI:1326151259
Name:STAROBIN, LISA S (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:STAROBIN
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 1:75 MOUNT AUBURN ST
Mailing Address - Street 2:HUHS
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4960
Mailing Address - Country:US
Mailing Address - Phone:617-495-2001
Mailing Address - Fax:617-496-0530
Practice Address - Street 1:75 MOUNT AUBURN ST
Practice Address - Street 2:HUHS
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4960
Practice Address - Country:US
Practice Address - Phone:617-495-2001
Practice Address - Fax:617-496-0530
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA205646OtherTUFTS HEALTH PLAN
MAJ25457OtherBC/BS OF MA
MAH58835Medicare UPIN
MAJ25457OtherBC/BS OF MA