Individual
R LISA KAUFMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
630 PLANTATION ST, WORCESTER, MA 01605
(508) 595-2505
(508) 854-0650
Mailing address
630 PLANTATION ST, WOT 12TH FLOOR ATTN PHYSICIAN SERVICES, WORCESTER, MA 01605
(508) 368-5529
(508) 368-5530
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200050
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0391310
MEDICAID WELFARE
—
05
—
0391310
—
MA
01
—
042472266
THREE RIVERS
—
01
—
042472266008
TRICARE CHAMPUS
—
01
—
61996
FALLON COMMUNITY HEALTH P
—
01
—
AA635
HARVARD PILGRIM HEALTHCAR
—
01
—
NP3652
BLUE SHIELD HMO BLUE
—
Enumeration date
02/28/2006
Last updated
04/28/2014
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