Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 273761 | MA |
NPI | 1003226226 |
---|---|
Provider Name | Lara Eisa |
First Address | Dorchester, MA 02125-3354 |
Second Address | Buffalo, NY 14214-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2014 |
Last Update Date | 23/08/2019 |