Healthcare Provider Details

I. General information

NPI: 1639127749
Provider Name (Legal Business Name): LISA M SYLVIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAPLE AVE SUITE 1
GREAT BARRINGTON MA
01230-1963
US

IV. Provider business mailing address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-4047
  • Fax: 413-528-3407
Mailing address:
  • Phone: 413-447-2752
  • Fax: 413-496-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number226623
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: