Provider Demographics
NPI:1972514180
Name:CARTER, LISA H (FAMILY PRACTICE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:CARTER
Suffix:
Gender:F
Credentials:FAMILY PRACTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 QUEEN ST
Mailing Address - Street 2:MEDICAL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2473
Mailing Address - Country:US
Mailing Address - Phone:508-860-7700
Mailing Address - Fax:508-860-7990
Practice Address - Street 1:26 QUEEN ST
Practice Address - Street 2:MEDICAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2473
Practice Address - Country:US
Practice Address - Phone:508-860-7700
Practice Address - Fax:508-860-7990
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA82283OtherCMSP
MAJ28480OtherBCBS
MAY10141OtherBCBS-GROUP
MA0035004OtherNHP
MA1300709Medicaid
MA92140OtherFALLON SELECT
MAAA27792OtherHARVARD PILGRIM
MA0006767OtherNHP-GROUP
MA96836401OtherNETWORK HEALTH
MAAA27792OtherHARVARD PILGRIM
MAH69099Medicare UPIN
MA1300709Medicaid
MA92140OtherFALLON SELECT
MA82283OtherCMSP