Provider Demographics
NPI:1023173721
Name:PANTHER, LORI ANN (MD, MPH)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:PANTHER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FRANCIS ST
Mailing Address - Street 2:LMOB SUITE G-B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5501
Mailing Address - Country:US
Mailing Address - Phone:617-632-7706
Mailing Address - Fax:617-632-7626
Practice Address - Street 1:110 FRANCIS ST
Practice Address - Street 2:LMOB SUITE G-B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5501
Practice Address - Country:US
Practice Address - Phone:617-632-7706
Practice Address - Fax:617-632-7626
Is Sole Proprietor?:No
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80590207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9758399OtherMASSHEALTH PROVIDER NUMBE
MAE99209Medicare UPIN