Healthcare Provider Details

I. General information

NPI: 1770534844
Provider Name (Legal Business Name): LISA A. PLANETA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MONTGOMERY ST
CHICOPEE MA
01020-1969
US

IV. Provider business mailing address

444 MONTGOMERY ST
CHICOPEE MA
01020-1969
US

V. Phone/Fax

Practice location:
  • Phone: 413-594-3111
  • Fax: 413-789-8048
Mailing address:
  • Phone: 413-594-3111
  • Fax: 413-789-8048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number79242
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number79242
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: