Individual
RICHARD G. LISTERUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
328 SHREWSBURY ST, WORCESTER, MA 01604-4613
(508) 856-2537
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
212869
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2010577
—
MA
Enumeration date
11/09/2005
Last updated
10/02/2013
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