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NPI Code Detail

MEDICARE: DR. LISA TRACY WOLLMAN MD

MEDICARE: DR. LISA TRACY WOLLMAN 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
1207LC0200XCritical Care Medicine (Anesthesiology) Physician77484MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2J13877OTHERMABCBS MA
3739827OTHERMATUFTS HEALTH PLAN

General Provider Information

NPI Number : 1578544748
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA TRACY WOLLMAN MD
Provider Business Mailing Address
First Line : 690 CANTON ST STE 240
Second Line :
City : WESTWOOD
State : MA
Zip : 02090-2326
Country : US
Telephone Number : 339-204-9516
Fax Number : 781-459-4698
Provider Business Practice Location Address
First Line : 690 CANTON ST STE 240
Second Line :
City : WESTWOOD
State : MA
Zip : 02090-2326
Country : US
Telephone Number : 339-204-9516
Fax Number : 781-459-4698
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 11/21/2019

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Directions to “ DR. LISA TRACY WOLLMAN MD” Practice Location

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