Provider Demographics
NPI:1730320540
Name:RISSMAN, JUDITH LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LYNN
Last Name:RISSMAN
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 1:240 E EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2134
Mailing Address - Country:US
Mailing Address - Phone:781-860-0842
Mailing Address - Fax:
Practice Address - Street 1:240 E EMERSON RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2134
Practice Address - Country:US
Practice Address - Phone:781-860-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine