1962486886 NPI number — LISA DAS M.D.

Table of content: LISA DAS M.D. (NPI 1962486886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962486886 NPI number — LISA DAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAS
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962486886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 TAMIE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201-8221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-236-0902
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
631B NORTH ST
Provider Second Line Business Practice Location Address:
GASTROENTEROLOGY OF THE BERKSHIRES
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-236-5944
Provider Business Practice Location Address Fax Number:
413-236-5944
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  159073 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10034406 . This is a "CAPITAL DISTRICT PHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 303392 . This is a "HAVARD PILGRAM HEALTH CAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7820068 . This is a "AMERICAN PIONEER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7820068 . This is a "AETNA HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5696434 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 57120688 . This is a "GHI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000024783 . This is a "BOSTON MEDICAL HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 02004180 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24861 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 57120168801201A001 . This is a "CHAMPUS TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 100811 . This is a "MVP HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 159073 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3207455 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J21391 . This is a "MA BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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