Individual
ELIZABETH M LIDSTONE JAYANATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
175 CONNORS STREET, GARDER, MA 01440
(978) 410-6100
(978) 410-6109
Mailing address
326 NICHOLS ROAD, FITCHBURG, MA 01420-1914
(978) 878-8100
(978) 878-8418
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
156974
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042472266
PRIVATE HEALTHCARE SYSTEM
—
01
—
1836498
FIRST HEALTH
—
01
—
3188787
MEDICAID/WELFARE
—
05
—
3188787
—
MA
01
—
33367
CHILDRENS MED SECURITY PL
—
01
—
42389
FALLON COMMUNITY HLTH PL
—
01
—
7521481
CIGNA HEALTH PLAN
—
01
—
7575320
AETNA/US HEALTHCARE
—
01
—
784154
MVP HEALTH CARE
—
01
—
A29170
MEDICARE B
—
01
—
AA1277
HARVARD PILGRIM HEALTHCAR
—
01
—
J19766
BLUE SHIELD HMO BLUE
—
Enumeration date
11/15/2005
Last updated
11/16/2015
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