Provider Demographics
NPI:1437147667
Name:VUKALCIC, LISA J (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:VUKALCIC
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:690 CANTON STREET
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2329
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:736 CAMBRIDGE STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2782
Practice Address - Fax:907-258-2147
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-12-14
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Provider Licenses
StateLicense IDTaxonomies
AK3105207L00000X
MA246553207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8428476OtherWA MEDICAID
AK050064949OtherMEDICARE RAILROAD
AKMD50901Medicaid
WA995202149OtherOFFICE OF WORKER'S COMP
AK050064949OtherMEDICARE RAILROAD
D52504Medicare UPIN