Provider Demographics
NPI:1699733469
Name:FERLEY, LISA RENEE (MD)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:FERLEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:25 COMMUNICATIONS WAY
Mailing Address - Street 2:MACC - REVENUE CYCLE
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1866
Mailing Address - Country:US
Mailing Address - Phone:508-957-8664
Mailing Address - Fax:508-957-8677
Practice Address - Street 1:40 QUINLAN WAY
Practice Address - Street 2:2ND FL, SUITE 206
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-778-8835
Practice Address - Fax:508-790-8989
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0361116112084N0400X
MA2377972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111611Medicaid
IL036111611Medicaid
G67555Medicare UPIN