Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | MD12732 | RI |
Y | 207VX0201X | Gynecologic Oncologist | MD18183 | ME |
NPI | 1518189349 |
---|---|
Provider Name | Jason A Lachance |
First Address | Scarborough, ME 04074-9701 |
Second Address | Scarborough, ME 04074-9692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 06/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30208744 | (05) | NH |
434243299 | (05) | ME |