Provider Demographics
NPI:1780622050
Name:GLADING-DILORENZO, LISE ANN (MD)
Entity type:Individual
Prefix:
First Name:LISE ANN
Middle Name:
Last Name:GLADING-DILORENZO
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 1:3640 MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1145
Mailing Address - Country:US
Mailing Address - Phone:413-739-0669
Mailing Address - Fax:413-739-0621
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-739-0669
Practice Address - Fax:413-739-0621
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine