Provider Demographics
NPI:1821535832
Name:BINGLEY, LISA (MED)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BINGLEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MERRIMACK ST
Mailing Address - Street 2:BUILDING 5, ENTRANCE F
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1740
Mailing Address - Country:US
Mailing Address - Phone:978-620-0290
Mailing Address - Fax:978-688-0531
Practice Address - Street 1:360 MERRIMACK ST
Practice Address - Street 2:BUILDING 5, ENTRANCE F
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1740
Practice Address - Country:US
Practice Address - Phone:978-620-0290
Practice Address - Fax:978-688-0531
Is Sole Proprietor?:No
Enumeration Date:2017-01-28
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program