Individual
LIDYA H WLASIUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
850 HARRISON AVE, YACC 5, BOSTON, MA 02118-4001
(617) 414-2080
(617) 414-2090
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207999
CA
207Q00000X
Family Medicine Physician
264803
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110102696A
—
MA
Enumeration date
05/11/2012
Last updated
04/28/2026
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