Provider Demographics
NPI:1831171644
Name:NOBLE, LISA B (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:B
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:563 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1300
Practice Address - Country:US
Practice Address - Phone:978-586-3939
Practice Address - Fax:978-586-3955
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA155953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110062132AMedicaid
MA3203743Medicaid
MANO A30390Medicare ID - Type Unspecified