Individual
DR. LISA MARIE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
85 SEYMOUR ST, SUITE 1019, HARTFORD, CT 06106-5501
(860) 246-4029
(860) 240-7072
Mailing address
2110 SILAS DEANE HWY, ROCKY HILL, CT 06067-2313
(860) 258-3470
(860) 571-6800
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0048223
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12682481
CAQH
CT
Enumeration date
06/29/2010
Last updated
06/17/2014
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