Prock, Lisa

Prock, Lisa is an individual health care provider with primary practice located at 300 Longwood Ave , Boston MA 02115-5724. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics. Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics is her primary health care specialty. Prock, Lisa can be contacted via phone (617) 355-4125.

Contact Information

Primary practice address
300 Longwood Ave Boston MA 02115-5724
Phone: (617) 355-4125
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 81196 Massachusetts
Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics 2080P0006X 81196 Massachusetts

Profile Details

NPI number 1609988823
LBN Legal business name Prock, Lisa
Credentials MD, MPH
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 1st, 2006
Last updated Mar 16th, 2016 - about 10 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 1609988823 NPPES
Massachusetts MEDICAID 3145550

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