Provider Demographics
NPI:1821042821
Name:LISTER, JOAN E (MD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:LISTER
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 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-447-2752
Mailing Address - Fax:413-496-6836
Practice Address - Street 1:2 PARK ST
Practice Address - Street 2:GYN
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220
Practice Address - Country:US
Practice Address - Phone:413-743-1263
Practice Address - Fax:413-743-0568
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43434207V00000X
VT420010796207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0146757Medicaid
J10044Medicare ID - Type Unspecified
MA0146757Medicaid