Healthcare Provider Details

I. General information

NPI: 1255876173
Provider Name (Legal Business Name): NICOLE LUNARDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2017
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FRANCIS ST STE 3A
BOSTON MA
02215-5501
US

IV. Provider business mailing address

110 FRANCIS ST STE 3A
BOSTON MA
02215-5501
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-9922
  • Fax: 617-632-0886
Mailing address:
  • Phone: 617-632-9922
  • Fax: 617-632-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1026373
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: