Healthcare Provider Details

I. General information

NPI: 1649490400
Provider Name (Legal Business Name): LISA FLAHERTY D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 PROSPECT ST
NANTUCKET MA
02554-2799
US

IV. Provider business mailing address

408 NEWBOLD RD
JENKINTOWN PA
19046-2851
US

V. Phone/Fax

Practice location:
  • Phone: 508-825-8270
  • Fax:
Mailing address:
  • Phone: 215-884-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number220403
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC2-0008522
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: