Provider Demographics
NPI:1972558559
Name:LORING, LISA A (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:LORING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2527 CRANBERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1046
Mailing Address - Country:US
Mailing Address - Phone:800-841-5200
Mailing Address - Fax:508-273-1241
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4132
Practice Address - Country:US
Practice Address - Phone:413-447-2453
Practice Address - Fax:413-447-2441
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1543102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013542Medicaid
NY01753584Medicaid
MA110058759AMedicaid
11085457OtherCAQH ID#
CT003120251Medicaid
11085457OtherCAQH ID#
NY01753584Medicaid