Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 57896 | MA |
N | 208000000X | Pediatrician | 57896 | MA |
Y | 2080P0202X | Pediatric Cardiologist | 57896 | MA |
NPI | 1770555138 |
---|---|
Provider Name | Ronald V Lacro |
First Address | Brookline, MA 02446-9135 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3085023 | (05) | MA |
A93109 | (02) | |
RL03673 | (05) | RI |