Healthcare Provider Details

I. General information

NPI: 1972558559
Provider Name (Legal Business Name): LISA A LORING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST RADIOLOGY DEPARTMENT
PITTSFIELD MA
01201-4132
US

IV. Provider business mailing address

2527 CRANBERRY HWY
WAREHAM MA
02571-1046
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-2453
  • Fax: 413-447-2441
Mailing address:
  • Phone: 800-841-5200
  • Fax: 508-273-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number154310
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: