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General NPI Number Information
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NPI Number | 1437147667
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Entity Type | Individual
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Provider Name | LISA J VUKALCIC M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 736 CAMBRIDGE STREET
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City | BOSTON
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State | MA
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Zip | 02135-2907
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Country | US
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Telephone | 617-789-2782
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Fax | 907-258-2147
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Provider Business Mailing Address
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Address Line | 690 CANTON STREET SUITE 325
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City | WESTWOOD
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State | MA
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Zip | 02090-2329
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Country | US
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Telephone | 781-407-7713
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Fax | 781-407-0998
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 3105
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 246553
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License Number State | MA
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