Provider Demographics
NPI:1750384046
Name:BALESTRERO, LORI M (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:M
Last Name:BALESTRERO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:960 MASSACHUSETTS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:617-414-7399
Mailing Address - Fax:617-414-4676
Practice Address - Street 1:801 MASSACHUSETTS AVENUE CROSSTOWN 2
Practice Address - Street 2:HOSPITALIST SERVICES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-7399
Practice Address - Fax:617-414-4676
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2024-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA205603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0109321Medicaid
MA0109321Medicaid
MDH18523Medicare UPIN