Provider Demographics
NPI:1316049950
Name:GILL, LISA MARIE (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:GILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:MASSACHUSETTS ANESTHESIA CORP.
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:617-323-1836
Mailing Address - Fax:
Practice Address - Street 1:50 STANIFORD STREET
Practice Address - Street 2:C/O MA ANESTHESIA CORP.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:781-341-3966
Practice Address - Fax:781-341-8269
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA76478207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050085831OtherRAILROAD MEDICARE
MA3104184Medicaid
MA97998308OtherNETWORK HEALTH
MA729284OtherTUFTS ASSOC HEALTH PLANS
MAJ13105OtherBLUE CROSS & BLUE SHIELD
MA275097OtherHARVARD PILGRIM HEALTH
MA275097OtherHARVARD PILGRIM HEALTH
MAJ13105OtherBLUE CROSS & BLUE SHIELD