Individual
DR. JOHN TIMOTHY LYSACK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, GRB 2, BOSTON, MA 02114-2621
(617) 726-8320
(617) 726-3077
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
224049
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2106621
—
MA
01
—
478705
TUFTS HEALTH PLAN
MA
01
—
J29081
BCBS MA
MA
Enumeration date
11/02/2005
Last updated
07/08/2007
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