Basic Information
| Provider Information | |||||||||
| NPI: | 1528049681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERRETTI | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COGLIANO | ||||||||
| OtherFirstName: | LISA | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 62 | ||||||||
| Address2: | TURNPIKE STATION | ||||||||
| City: | SHREWSBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015450062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083348815 | ||||||||
| FaxNumber: | 5083345374 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 PROSPECT ST | ||||||||
| Address2: | DEPARTMENT OF PEDIATRIC HOSPITAL MEDICINE | ||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017573003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084731190 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 08/27/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 216551 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2076837 | 05 | MA | MEDICAID |