Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 25MA10141900 | NJ |
N | 2086S0102X | Surgical Critical Care | LP03631 | RI |
NPI | 1043535180 |
---|---|
Provider Name | Dr. Marc William Lafonte |
First Address | Providence, RI 02903-4923 |
Second Address | New Brunswick, NJ 08901-1928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2010 |
Last Update Date | 23/07/2021 |