Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 1471 | MA |
NPI | 1003812280 |
---|---|
Provider Name | Ronald G. Lavenda |
First Address | Clinton, MA 01510-1037 |
Second Address | Clinton, MA 01510-1037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 03/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T58679 | (02) | MA |