Provider Demographics
NPI:1780665190
Name:WARREN, LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:ANESTHESIA ASSOCIATES CLN 309
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-8590
Practice Address - Fax:617-726-8984
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA204380207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0144461Medicaid
MAJ23763OtherBCBS MA
MA204380OtherTUFTS HEALTH PLAN
MA204380OtherTUFTS HEALTH PLAN
MAA32822Medicare ID - Type Unspecified