Basic Information
| Provider Information | |||||||||
| NPI: | 1821042821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LISTER | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134472752 | ||||||||
| FaxNumber: | 4134966836 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 PARK ST | ||||||||
| Address2: | GYN | ||||||||
| City: | ADAMS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137431263 | ||||||||
| FaxNumber: | 4137430568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 02/11/2010 | ||||||||
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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 | 207V00000X | 43434 | MA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 420010796 | VT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0146757 | 05 | MA | MEDICAID |