Healthcare Provider Details

I. General information

NPI: 1003966268
Provider Name (Legal Business Name): LISA MARIE LAZARZ-CIESLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 INFIRMARY WAY
AMHERST MA
01003
US

IV. Provider business mailing address

150 INFIRMARY WAY
AMHERST MA
01003-9288
US

V. Phone/Fax

Practice location:
  • Phone: 413-577-5000
  • Fax: 413-577-5023
Mailing address:
  • Phone: 413-577-5000
  • Fax: 413-577-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number159500
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: