Healthcare Provider Details

I. General information

NPI: 1437175106
Provider Name (Legal Business Name): LISA MARIE VIEIRA-SALVATORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL ROAD
OAK BLUFFS MA
02557
US

IV. Provider business mailing address

10 POND VIEW CIR
VINEYARD HAVEN MA
02568-3920
US

V. Phone/Fax

Practice location:
  • Phone: 508-957-0111
  • Fax:
Mailing address:
  • Phone: 508-338-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number036231
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036231
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number14043
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number250447
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: