Provider Demographics
NPI:1437563723
Name:CISZAK, LAUREN M (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:CISZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1564
Mailing Address - Country:US
Mailing Address - Phone:509-865-5600
Mailing Address - Fax:509-865-5783
Practice Address - Street 1:10 GOVE ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1920
Practice Address - Country:US
Practice Address - Phone:617-569-5800
Practice Address - Fax:617-568-4756
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA281457207Q00000X
WAMD60813123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine