Provider Demographics
NPI:1497773923
Name:DILLER, LISA ROBIN (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ROBIN
Last Name:DILLER
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 1:44 BINNEY STREET
Mailing Address - Street 2:D 1646
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-632-5642
Mailing Address - Fax:617-582-8218
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:300 LONGWOOD AVENUE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA596842080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
J10214OtherBCBS OF MA
6563998OtherCIGNA
J10214OtherHMO BLUE
23287OtherFALLON COMM HEALTH PLAN
E54937DFOtherHPHC DFCI ONLY
J10214OtherINDEMNITY
J10214OtherBC ELECT
059684OtherTUFTS
2927582OtherAETNA US HEALTHCARE
3082431OtherMASSHEALTH MA MEDICAID
J10214OtherBC ELECT
E54937DFOtherHPHC DFCI ONLY