Provider Demographics
NPI:1770791030
Name:NAGY, LISA LAVINE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LAVINE
Last Name:NAGY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24 COURNOYER RD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-7625
Mailing Address - Country:US
Mailing Address - Phone:508-693-1300
Mailing Address - Fax:508-693-1305
Practice Address - Street 1:24 COURNOYER RD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-7625
Practice Address - Country:US
Practice Address - Phone:508-693-1300
Practice Address - Fax:508-639-1305
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA72590208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110086513AMedicaid
MA110086513AMedicaid