MEDICARE: MS. LISA DOMAL SWEENEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	150105	MA
2	207Q00000X	Family Medicine Physician	150105	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	J19779	OTHER	MA	BCBS
3	711529	OTHER	MA	HPHC

General Provider Information

NPI Number	:	1083726194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA DOMAL SWEENEY M.D.

Provider Business Mailing Address
First Line	:	15 ROCHE BROS WAY STE 220
Second Line	:	ONE WASHINGTON ST
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1000
Country	:	US
Telephone Number	:	508-230-0155
Fax Number	:	508-230-0145

Provider Business Practice Location Address
First Line	:	15 ROCHE BROS WAY STE 220
Second Line	:	ONE WASHINGTON ST
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1000
Country	:	US
Telephone Number	:	508-230-0155
Fax Number	:	508-230-0145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/10/2012

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