Lisa Prussick, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

280404 Issued in MA

Practice address

800 Washington Street
Biewend 14TH Floor
Boston, MA 02116

Phone

(617) 636-1576

NPI assigned

Jun 2, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1609434950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON STREET",
            "address_2": "BIEWEND 14TH FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02116",
            "telephone_number": "617-636-1576"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Dorchester Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021245615",
            "country_code": "US",
            "telephone_number": "617-506-2726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRUSSICK",
        "first_name": "LISA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-02",
        "last_updated": "2023-05-09",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MA",
            "license": "280404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Prudent, MD
• Prudential Dental Associates Inc.
• John V. Pruitt III, M.D.
• Karisha Moneake Pruitt, RN
• Scott G Prushik, M.D.
• Sushruta Prusty, M.D.
• Jeremy Joseph Pruzin, MD
• Katherine Pryor, MD
• Jennifer A Przybylo, MD, MPHIL
• Eric M Przybyszewski, MD

• Dermatology Physician in Boston, MA
• Providers in Boston, MA by specialty
• Dermatology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.