Provider Demographics
NPI:1982685913
Name:STEPHENS, LISA L (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1324
Mailing Address - Country:US
Mailing Address - Phone:413-533-2900
Mailing Address - Fax:413-568-4634
Practice Address - Street 1:395 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1324
Practice Address - Country:US
Practice Address - Phone:413-533-2900
Practice Address - Fax:413-568-4634
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160181207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3196712Medicaid
MAS400115648Medicare PIN
MA24696OtherHEALTH NEW ENGLAND
MA3196712Medicaid
MA042508583OtherGREAT-WEST HEALTH PLAN
MA042508583OtherNORTHEAST HEALTH DIRECT
MA042508583OtherPRIVATE HEALTH CARE SYS
MA524273OtherCIGNA
MDJ21255OtherBCBS MA
MA131180OtherHARVARD PILGRIM
MA160181OtherCONNECTICARE
MA042508583OtherPLAN VISTA
MD042508583OtherCONSOLIDATED HEALTH PLANS
MA042508583OtherNORTH AMERICAN PREFERRED
MA160181OtherTUFTS
A29599Medicare ID - Type Unspecified
MA2359425OtherAETNA
G93127Medicare UPIN