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1679579205

NPI Code Detail

MEDICARE: LISA A FERZOCO M.D.

MEDICARE: LISA A FERZOCO 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	208600000X	Surgery Physician	205372	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
16	P00010450	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0125211	OTHER		MASS HEALTH
2	802591	OTHER		HARVARD PILGRIM POS
3	J23135	OTHER		HMO BLUE/BLUE CHOICE
4	17-01327	OTHER		UNITED HEALTH CARE
5	205372	OTHER		TUFTS
6	205372	OTHER		TUFTS SECURE HORIZONS
7	205372	OTHER		TUFTS BENEFIT ADMIN
8	205372	OTHER		TUFTS TOTAL HEALTH PLAN
9	0022279	OTHER		NEIGHBORHOOD HEALTH PLAN
10	1960770	OTHER		HEALTHSOURCE-MA
11	802591	OTHER		FIRST SENIORITY
12	J23135	OTHER		BS-BLUSE CARE ELECT
13	1950770	OTHER		CIGNA HEALTH CARE
14	40254	OTHER		CHILDREN'S MEDICAL SECURI
15	J23135	OTHER		BLUE SHIELD INDEMNITY
17	205372	OTHER		TUFTS COMMONWELATH
18	802591	OTHER		HARVARD PILGRIM PPO

General Provider Information

NPI Number	:	1679579205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA A FERZOCO M.D.

Provider Business Mailing Address
First Line	:	63 NORFOLK RD
Second Line	:
City	:	MILLIS
State	:	MA
Zip	:	02054-1723
Country	:	US
Telephone Number	:	508-726-1072
Fax Number	:	617-754-6430

Provider Business Practice Location Address
First Line	:	1493 CAMBRIDGE ST DEPT OF
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-1099
Country	:	US
Telephone Number	:	617-665-2555
Fax Number	:

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	01/19/2022

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Directions to “ LISA A FERZOCO M.D.” Practice Location

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