Provider Demographics
NPI:1821055773
Name:PUGH, LISA J (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:PUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 BROADWAY STE 101-I
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-4521
Mailing Address - Country:US
Mailing Address - Phone:781-832-0035
Mailing Address - Fax:
Practice Address - Street 1:999 BROADWAY STE 101-I
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4521
Practice Address - Country:US
Practice Address - Phone:781-832-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197514363L00000X, 363LA2200X, 363LP0808X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA39158OtherHARVARD PILGRIM
MA0374971Medicaid
MANP3032OtherBLUE CROSS
MA0374971Medicaid
MA39158OtherHARVARD PILGRIM