Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD15584 | RI |
NPI | 1003077090 |
---|---|
Provider Name | Lars Stangenberg |
First Address | Rumford, RI 02916-0697 |
Second Address | Providence, RI 02905-3236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 10/01/2017 |