Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 209068 | MA |
NPI | 1023093945 |
---|---|
Provider Name | Lori Dilorenzo |
First Address | Worcester, MA 01608-2420 |
Second Address | Worcester, MA 01608-2420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 07/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1320815 | (05) | MA |
221868 | UGS (01) | MA |
H48935 | (02) | MA |
M18970 | BLUE SHIELD OF MA (01) | MA |