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Individual

LISA S GUSSAK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
26 QUEEN ST, FAMILY PRACTICE 1, WORCESTER, MA 01610-2473
(508) 860-7700
(508) 860-7929
Mailing address
26 QUEEN ST, FAMILY PRACTICE 1, WORCESTER, MA 01610-2473
(508) 860-7700
(508) 860-7929

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
155167
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0109061
MA
Enumeration date
11/25/2005
Last updated
10/24/2018
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