Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 39891 | MA |
N | 208000000X | Pediatrician | 39891 | MA |
N | 2080A0000X | Adolescent Medicine | 39891 | MA |
N | 2080P0006X | Developmental - Behavioral Pediatrician | 39891 | MA |
N | 2080P0201X | Pediatric Allergist | 39891 | MA |
N | 2080P0205X | Pediatric Endocrinologist | 39891 | MA |
N | 2080P0206X | Pediatric Gastroenterologist | 39891 | MA |
N | 2080P0208X | Pediatric Infectious Diseases | 39891 | MA |
N | 2080P0214X | Pediatric Pulmonologist | 39891 | MA |
N | 208D00000X | General Practice Physician | 39891 | MA |
NPI | 1770690141 |
---|---|
Provider Name | Dr. Nicholas Thomas Lacava |
First Address | West Boylston, MA 01583-2365 |
Second Address | West Boylston, MA 01583-2365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030891 | TUFTS PROVIDER ID (01) | MA |
2045842 | (05) | MA |
D88264 | (02) | MA |
E11028 | BLUE CROSS PROVIDER ID (01) | MA |