Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 4571 | MA |
NPI | 1134245285 |
---|---|
Provider Name | Mr. Mark Thomas Lareau |
First Address | North Easton, MA 02356-2240 |
Second Address | North Easton, MA 02356-2240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |