Provider Demographics
NPI:1023093945
Name:DILORENZO, LORI (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DILORENZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:DILORENZO
Other - Last Name:BUSZKIEWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 MECHANIC ST
Mailing Address - Street 2:ATTN: DAMARIS DIAZ
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2420
Mailing Address - Country:US
Mailing Address - Phone:508-792-5400
Mailing Address - Fax:508-831-0074
Practice Address - Street 1:10 MECHANIC ST
Practice Address - Street 2:ATTN: DAMARIS DIAZ
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2420
Practice Address - Country:US
Practice Address - Phone:508-792-5400
Practice Address - Fax:508-831-0074
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209068207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18970OtherBLUE SHIELD OF MA
MA221868OtherUGS
MA1320815Medicaid
MAH48935Medicare UPIN
MAA33074Medicare ID - Type Unspecified
MA1320815Medicaid