Provider Demographics
NPI:1962486886
Name:DAS, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DAS
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 1:26 TAMIE WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8221
Mailing Address - Country:US
Mailing Address - Phone:413-236-0902
Mailing Address - Fax:
Practice Address - Street 1:631B NORTH ST
Practice Address - Street 2:GASTROENTEROLOGY OF THE BERKSHIRES
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4102
Practice Address - Country:US
Practice Address - Phone:413-236-5944
Practice Address - Fax:413-236-5944
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159073174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10034406OtherCAPITAL DISTRICT PHP
MA303392OtherHAVARD PILGRAM HEALTH CAR
MA7820068OtherAMERICAN PIONEER
MA7820068OtherAETNA HEALTH CARE
MD5696434OtherCIGNA HEALTH CARE
MA57120688OtherGHI
MA000000024783OtherBOSTON MEDICAL HEALTHNET
NY02004180Medicaid
MA24861OtherHEALTH NEW ENGLAND
MA57120168801201A001OtherCHAMPUS TRICARE
MA100811OtherMVP HEALTH CARE
MA159073OtherTUFTS HEALTH PLAN
MA3207455Medicaid
MAJ21391OtherMA BLUE CROSS BLUE SHIELD
MA7820068OtherAMERICAN PIONEER
MA24861OtherHEALTH NEW ENGLAND
NY02004180Medicaid