Bergersen, Lisa

Bergersen, Lisa is an individual health care provider with primary practice located at 300 Longwood Ave , Boston MA 02115-5724. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Cardiology, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Cardiology. Allopathic & Osteopathic Physicians / Pediatric Cardiology is her primary health care specialty. Bergersen, Lisa can be contacted via phone (617) 335-7893.

Contact Information

Primary practice address
300 Longwood Ave Boston MA 02115-5724
Phone: (617) 335-7893
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 160372 Massachusetts
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 160372 Massachusetts
Allopathic & Osteopathic Physicians / Pediatric Cardiology 2080P0202X 160372 Massachusetts

Profile Details

NPI number 1942299730
LBN Legal business name Bergersen, Lisa
Credentials MD MPH
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 14th, 2005
Last updated Nov 21st, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942299730 NPPES
Massachusetts MEDICAID 2039290
Massachusetts Other 28244
Massachusetts Other J27337
Massachusetts Other J27337
Massachusetts Other 468809
Massachusetts Other 96969201
Massachusetts Other 2501928
Massachusetts Other J27337
Massachusetts MEDICAID LB54040

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