Provider Demographics
NPI:1679579205
Name:FERZOCO, LISA A (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:FERZOCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:63 NORFOLK RD
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1723
Mailing Address - Country:US
Mailing Address - Phone:508-726-1072
Mailing Address - Fax:617-754-6430
Practice Address - Street 1:1493 CAMBRIDGE ST DEPT OF
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1099
Practice Address - Country:US
Practice Address - Phone:617-665-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205372208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0125211OtherMASS HEALTH
802591OtherHARVARD PILGRIM POS
J23135OtherHMO BLUE/BLUE CHOICE
17-01327OtherUNITED HEALTH CARE
205372OtherTUFTS
205372OtherTUFTS SECURE HORIZONS
205372OtherTUFTS BENEFIT ADMIN
205372OtherTUFTS TOTAL HEALTH PLAN
0022279OtherNEIGHBORHOOD HEALTH PLAN
1960770OtherHEALTHSOURCE-MA
802591OtherFIRST SENIORITY
J23135OtherBS-BLUSE CARE ELECT
1950770OtherCIGNA HEALTH CARE
40254OtherCHILDREN'S MEDICAL SECURI
J23135OtherBLUE SHIELD INDEMNITY
P00010450OtherRAILROAD MEDICARE
205372OtherTUFTS COMMONWELATH
802591OtherHARVARD PILGRIM PPO
802591OtherHARVARD PILGRIM PPO
0125211OtherMASS HEALTH