Organization
LISA ANTONELLI MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA ANTONELLI MD (PRESIDENT)
(617) 472-6953
Entity
Organization
Contact information
Practice address
500 CONGRESS ST, STE 2F, QUINCY, MA 02169-0908
(617) 472-6953
(617) 773-2193
Mailing address
460 TOTTEN POND RD, C O MZI, WALTHAM, MA 02451-1906
(781) 890-9933
(781) 890-9950
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3060284
—
MA
01
—
755370
TUFTS
MA
01
—
J09499
BCBS
MA
Enumeration date
10/21/2005
Last updated
08/22/2020
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