Healthcare Provider Details

I. General information

NPI: 1366601726
Provider Name (Legal Business Name): DIANA C LEMLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT STREET
BOSTON MA
02114
US

IV. Provider business mailing address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT STREET
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-7782
  • Fax:
Mailing address:
  • Phone: 617-726-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number249702
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number249702
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: