Provider Demographics
NPI:1487677027
Name:CONNOLLY, LISA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:628 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2340
Mailing Address - Country:US
Mailing Address - Phone:781-598-4424
Mailing Address - Fax:781-598-0630
Practice Address - Street 1:6 KIMBALL LN
Practice Address - Street 2:LAHEY LYNNFIELD
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2682
Practice Address - Country:US
Practice Address - Phone:781-213-4040
Practice Address - Fax:781-213-5064
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA154744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110059943AMedicaid
MAG73631Medicare UPIN
MA110059943AMedicaid