Individual
LISE J TARDIF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FAMILY PRACTICE
Contact information
Practice address
26 QUEEN ST, MEDICAL, WORCESTER, MA 01610-2473
(508) 860-7700
(508) 860-7990
Mailing address
26 QUEEN ST, MEDICAL, WORCESTER, MA 01610-2473
(508) 860-7700
(508) 860-7990
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
76680
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002565
NHP
MA
01
—
0006767
NHP-GROUP
MA
01
—
1300709
CMSP-GROUP
MA
05
—
1300709
—
MA
01
—
2198604
UNITED HEALTHCARE
MA
01
—
23507
CMSP
MA
01
—
347293
CIGNA
MA
01
—
36702
FALLON SELECT
MA
01
—
70951
HARVARD PILGRIM
MA
01
—
99734901
NETWORK HEALTH
MA
01
—
Y10141
BCBS-GROUP
MA
Enumeration date
08/12/2006
Last updated
07/09/2007
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