Healthcare Provider Details

I. General information

NPI: 1326151259
Provider Name (Legal Business Name): LISA S. STAROBIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MOUNT AUBURN ST HUHS
CAMBRIDGE MA
02138-4960
US

IV. Provider business mailing address

75 MOUNT AUBURN ST HUHS
CAMBRIDGE MA
02138-4960
US

V. Phone/Fax

Practice location:
  • Phone: 617-495-2001
  • Fax: 617-496-0530
Mailing address:
  • Phone: 617-495-2001
  • Fax: 617-496-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number205646
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: