Organization
VINEYARD PERSONALIZED MEDICINE LLC
Active
Other names
Environmental Health Center of Martha's Vineyard
Organization subpart
No
Provider details
NPI number
Authorized official
LISA NAGY MD (SOLE PROPRIETOR)
(508) 693-1300
Entity
Organization
Contact information
Practice address
24 COURNOYER RD, WEST TISBURY, MA 02575
(508) 693-1300
(508) 693-1305
Mailing address
24 COURNOYER RD, VINEYARD HAVEN, MA 02568-7625
(508) 693-1300
(508) 693-1305
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
72590
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11009334A
—
MA
Enumeration date
05/31/2012
Last updated
11/25/2015
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