Provider Demographics
NPI:1922055664
Name:MCHAM, MARY LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY LISA
Middle Name:
Last Name:MCHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:97 LIBBEY INDUSTRIAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3110
Mailing Address - Country:US
Mailing Address - Phone:781-331-3300
Mailing Address - Fax:781-337-8356
Practice Address - Street 1:97 LIBBEY INDUSTRIAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:EAST WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3110
Practice Address - Country:US
Practice Address - Phone:781-331-3300
Practice Address - Fax:781-337-8356
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77904207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110053096AMedicaid
MAJ13871OtherMEDICARE