Healthcare Provider Details

I. General information

NPI: 1093917296
Provider Name (Legal Business Name): LISA A. RAMPONE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N PEARL ST
BROCKTON MA
02301-1794
US

IV. Provider business mailing address

88 WASHINGTON ST
TAUNTON MA
02780-2465
US

V. Phone/Fax

Practice location:
  • Phone: 508-427-3000
  • Fax:
Mailing address:
  • Phone: 508-828-7100
  • Fax: 508-828-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00203
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: