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General NPI Number Information
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NPI Number | 1336182260
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Entity Type | Individual
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Provider Name | JAMES CHESTER LISAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 360 FAUNCE CORNER RD # 3
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City | NORTH DARTMOUTH
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State | MA
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Zip | 02747-1257
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Country | US
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Telephone | 774-202-6240
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Fax | 774-202-5179
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Provider Business Mailing Address
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Address Line | PO BOX 79141
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City | NORTH DARTMOUTH
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State | MA
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Zip | 02747-0991
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Country | US
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Telephone | 774-202-6240
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Fax | 774-202-5179
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 52025
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 52025
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License Number State | MA
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