Provider Demographics
NPI:1003812280
Name:LAVENDA, RONALD G (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:LAVENDA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HIGHLAND ST
Mailing Address - Street 2:SUITE C CLINTON HOSPITAL
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-1037
Mailing Address - Country:US
Mailing Address - Phone:978-368-3990
Mailing Address - Fax:978-368-3993
Practice Address - Street 1:201 HIGHLAND ST
Practice Address - Street 2:SUITE C CLINTON HOSPITAL
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1037
Practice Address - Country:US
Practice Address - Phone:978-368-3990
Practice Address - Fax:978-368-3993
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1471213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0561100002Medicare NSC
MAT58679Medicare UPIN
MA0561100001Medicare NSC
MAY70600Medicare PIN