Provider Demographics
NPI:1346230521
Name:NACHTIGALL, LISA B (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:B
Last Name:NACHTIGALL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-7948
Mailing Address - Fax:617-726-1241
Practice Address - Street 1:ZERO EMERSON PLACE
Practice Address - Street 2:STE 112 NEUROENDOCRINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-7948
Practice Address - Fax:617-726-1241
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-11-13
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Provider Licenses
StateLicense IDTaxonomies
MA152939207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA766747OtherTUFTS HEALTH PLAN
MA3163059Medicaid
MAJ17361OtherBCBS MA
MA3163059Medicaid
G37171Medicare UPIN