Basic Information
Provider Information | |||||||||
NPI: | 1528033305 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WEINSTEIN MORENO | ||||||||
FirstName: | LISA | ||||||||
MiddleName: | F | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WEINSTEIN | ||||||||
OtherFirstName: | LISA | ||||||||
OtherMiddleName: | F | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 297 NORTH ST STE 221 | ||||||||
Address2: |   | ||||||||
City: | HYANNIS | ||||||||
State: | MA | ||||||||
PostalCode: | 026015133 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 0858627777 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5 INDUSTRIAL DR | ||||||||
Address2: |   | ||||||||
City: | MASHPEE | ||||||||
State: | MA | ||||||||
PostalCode: | 026493464 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5087784777 | ||||||||
FaxNumber: | 5087719555 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/23/2006 | ||||||||
LastUpdateDate: | 06/17/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 222899 | MA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207R00000X | 222899 | MA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | AA22191 | 01 | MA | HPHC | OTHER | J28282 | 01 | MA | BCBS | OTHER |