Individual
LISA F ANTONELLI
Active
Individual
LISA F ANTONELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
72272
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3060284
—
MA
01
—
60264
HPHC
MA
01
—
755370
TUFTS
MA
01
—
J09499
BCBS
MA
Enumeration date
10/21/2005
Last updated
11/04/2011
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