Active NPI
Lisa Antonelli MD
- Cardiovascular Disease Physician
- Quincy, MA
National Provider Identifier
1235129222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- Legal business name
- LISA ANTONELLI MD
- Practice address
- 500 Congress St
Ste 2F
Quincy, MA 02169-0908 - Phone
- (617) 472-6953
- Fax
- (617) 773-2193
- NPI assigned
- Oct 21, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lisa Antonelli, MD
- Title
- President
- Phone
- (617) 472-6953
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | Primary |
Addresses
Primary practice location
500 Congress St
Ste 2F
Quincy, MA 02169-0908
Mailing address
460 Totten Pond Rd
C O Mzi
Waltham, MA 02451-1906
Phone (781) 890-9933
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J09499 | Other | MA | BCBS |
| 3060284 | Medicaid | MA | |
| 755370 | Other | MA | TUFTS |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Cardiovascular Disease Physician
- Dorchester, MA
- NPI 1639169618
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1235129222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "460 TOTTEN POND RD",
"address_2": "C O MZI",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511906",
"telephone_number": "781-890-9933",
"fax_number": "781-890-9950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 CONGRESS ST",
"address_2": "STE 2F",
"city": "QUINCY",
"state": "MA",
"postal_code": "021690908",
"telephone_number": "617-472-6953",
"fax_number": "617-773-2193"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LISA ANTONELLI MD",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-21",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "ANTONELLI",
"authorized_official_first_name": "LISA",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "617-472-6953",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "J09499",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3060284",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "755370",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Quincy, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.