Provider Demographics
NPI:1447284104
Name:ZISBLATT, LAURA WALPERT (MD)
Entity type:Individual
Prefix:
First Name:LAURA WALPERT
Middle Name:
Last Name:ZISBLATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KNIFE SHOP LN
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2275
Mailing Address - Country:US
Mailing Address - Phone:508-429-2800
Mailing Address - Fax:
Practice Address - Street 1:HOLLISTON PEDIATRIC GRP
Practice Address - Street 2:100 JEFFREY AVE
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746
Practice Address - Country:US
Practice Address - Phone:508-429-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71264208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics