Provider Demographics
NPI:1780663344
Name:GLANTZ, LISA K (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:GLANTZ
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 1:30 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2052
Mailing Address - Country:US
Mailing Address - Phone:413-582-2175
Mailing Address - Fax:413-582-2954
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-582-2175
Practice Address - Fax:413-582-2954
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80978207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA34748OtherHARVARD PILGRIM
MA0809978OtherCONNECTICARE
MA102481OtherCIGNA
MA00000006747OtherBMC
MAJ16070OtherBCBS MA
MA080978OtherTUFTS
MA3137554Medicaid
MA2376655OtherAETNA
MA24956OtherHEALTH NEW ENGLAND
MA102481OtherCIGNA
MAGL16070Medicare ID - Type Unspecified