Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 225657 | MA |
Y | 2080P0201X | Pediatric Allergist | 225657 | MA |
NPI | 1578730990 |
---|---|
Provider Name | Dr. Lisa Marie Bartnikas |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 26/06/2011 |