Individual
JAMES CHESTER LISAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
360 FAUNCE CORNER RD, # 3, NORTH DARTMOUTH, MA 02747-1257
(774) 202-6240
(774) 202-5179
Mailing address
PO BOX 79141, NORTH DARTMOUTH, MA 02747-0991
(774) 202-6240
(774) 202-5179
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
52025
MA
2084N0400X
Neurology Physician
Primary
52025
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3017117
—
MA
01
—
J06006
BLUE SHIELD MASSACHUSETTS
MA
Enumeration date
06/14/2006
Last updated
08/03/2016
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