Provider Demographics
NPI:1578544748
Name:WOLLMAN, LISA TRACY (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:TRACY
Last Name:WOLLMAN
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 1:690 CANTON ST STE 240
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2326
Mailing Address - Country:US
Mailing Address - Phone:339-204-9516
Mailing Address - Fax:781-459-4698
Practice Address - Street 1:690 CANTON ST STE 240
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2326
Practice Address - Country:US
Practice Address - Phone:339-204-9516
Practice Address - Fax:781-459-4698
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77484207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3108759Medicaid
MAJ13877OtherBCBS MA
MA739827OtherTUFTS HEALTH PLAN
MA3108759Medicaid
MAJ13877OtherBCBS MA