Healthcare Provider Details

I. General information

NPI: 1922453471
Provider Name (Legal Business Name): LISA SCOTT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MOUNT AUBURN ST STE 316
CAMBRIDGE MA
02138-5665
US

IV. Provider business mailing address

330 MOUNT AUBURN ST PARSONS 2
CAMBRIDGE MA
02138-5597
US

V. Phone/Fax

Practice location:
  • Phone: 617-868-0880
  • Fax: 617-499-5441
Mailing address:
  • Phone: 617-868-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS024011
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number33208
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number292182
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number292182
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: