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General NPI Number Information
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NPI Number | 1144415332
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Entity Type | Organization
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Legal Business Name | JULIUS LISTER, M.D., SURGERY OF INFANTS AND CHILDREN, INC.
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 61 LINCOLN ST
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City | FRAMINGHAM
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State | MA
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Zip | 01702-8264
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Country | US
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Telephone | 508-872-0616
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Fax | 508-879-5511
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Provider Business Mailing Address
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Address Line | 61 LINCOLN ST
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City | FRAMINGHAM
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State | MA
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Zip | 01702-8264
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Country | US
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Telephone | 508-872-0616
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Fax | 508-879-5511
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIUS LISTER
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Credential | M.D.
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Telephone | 508-872-0616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 27610
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License Number State | MA
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