Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 1553 | MA |
NPI | 1013001742 |
---|---|
Provider Name | Lara H Baldasaro |
First Address | Falmouth, MA 02540 |
Second Address | Falmouth, MA 02540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 26/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00784759 | RAILROAD MEDICARE PTAN (01) | MA |
P75982 | (02) | MA |