Individual
DR. LISE S KOWALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
130 FISHER RD, SUITE 3-1, BERLIN, VT 05602-9516
(802) 225-7000
Mailing address
94 WEST HILL RD, WORCESTER, VT 05682
(802) 225-7047
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
420008605
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01206986
—
NY
05
—
OVN0444
—
VT
Enumeration date
07/26/2006
Last updated
08/13/2013
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