MEDICARE: LISA J GOULD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	269554	MA

General Provider Information

NPI Number	:	1255443842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA J GOULD MD

Provider Business Mailing Address
First Line	:	118 VALENTINE CIR # 112
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-9115
Country	:	US
Telephone Number	:	409-789-8212
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 FOGG RD
Second Line	:
City	:	WEYMOUTH
State	:	MA
Zip	:	02190-2455
Country	:	US
Telephone Number	:	781-624-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/17/2020

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