Healthcare Provider Details

I. General information

NPI: 1083676431
Provider Name (Legal Business Name): LISA MICHELE COHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CRANBERRY HL STE 303
LEXINGTON MA
02421-7397
US

IV. Provider business mailing address

1 CRANBERRY HL STE 303
LEXINGTON MA
02421-7397
US

V. Phone/Fax

Practice location:
  • Phone: 781-290-0057
  • Fax: 781-290-0059
Mailing address:
  • Phone: 781-290-0057
  • Fax: 781-290-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number80079
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: