Provider Demographics
NPI:1861447807
Name:KENNEY, LISA BRAZZAMANO (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:BRAZZAMANO
Last Name:KENNEY
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 1:77 FOX RUN RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776
Mailing Address - Country:US
Mailing Address - Phone:918-443-5729
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:DANA FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-2292
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA819912080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
97496OtherFALLON COMMUNITY HEALTH P
J16320OtherBCBS OF MA, INDEMNITY, BC
081991OtherTUFTS
3145425OtherMASS HEALTH (MA MEDICAID)
9358OtherHPHC (DFCI ONLY)
1888596OtherCIGNA
97496OtherFALLON COMMUNITY HEALTH P
A20909Medicare ID - Type Unspecified