Provider Demographics
NPI:1750344008
Name:WIRTH, LORI J (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:J
Last Name:WIRTH
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 1:62 ESTES ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902
Mailing Address - Country:US
Mailing Address - Phone:617-671-3090
Mailing Address - Fax:617-632-4448
Practice Address - Street 1:44 BINNEY ST SW 430
Practice Address - Street 2:DFCI HEAD AND NECK ONCOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-3090
Practice Address - Fax:617-692-4448
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205729207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
205729OtherTUFTS
80324OtherFALLON COMMUNITY HEALTH P
3233469OtherAETNA US HEALTHCARE
3600266OtherUNITED HEALTH CARE
154526OtherHPHC DFCI ONLY
MAJ24007OtherBCBS INDEMITY BC ELECT HM
2336581OtherCIGNA
2006545OtherMASSHEALTH MA MEDICAID
205729OtherTUFTS
80324OtherFALLON COMMUNITY HEALTH P