Individual
MS. KORI LANCIOTTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 726-5201
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 726-5201
(617) 726-7667
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1975
NH
363A00000X
Physician Assistant
Primary
4620
MA
363AM0700X
Medical Physician Assistant
4620
MA
363AS0400X
Surgical Physician Assistant
4620
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3127183
—
NH
Enumeration date
04/12/2013
Last updated
02/21/2023
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