Provider Demographics
NPI:1588747323
Name:LYSIAK, PAUL L
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:LYSIAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 OLD ROAD TO 9 ACRE COR
Mailing Address - Street 2:EMERSON HOSPITAL, DEPT. OF PATHOLOGY
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 OLD RD TO NINE ACRE CORNER
Practice Address - Street 2:EMERSON HOSPITAL, DEPT. OF PATHOLOGY
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-287-3355
Practice Address - Fax:978-287-3656
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76442207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ14526Medicare ID - Type Unspecified