Healthcare Provider Details

I. General information

NPI: 1366557027
Provider Name (Legal Business Name): LISA LAGO NORRIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HUMMINGBIRD HOLW
SOUTHWICK MA
01077-9530
US

IV. Provider business mailing address

5 HUMMINGBIRD HOLW
SOUTHWICK MA
01077-9530
US

V. Phone/Fax

Practice location:
  • Phone: 413-569-0884
  • Fax:
Mailing address:
  • Phone: 413-569-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77086
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: