Provider Demographics
NPI:1013001742
Name:BALDASARO, LARA H (PA)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:H
Last Name:BALDASARO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 GIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540
Mailing Address - Country:US
Mailing Address - Phone:508-457-4900
Mailing Address - Fax:508-457-4911
Practice Address - Street 1:360 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-457-4900
Practice Address - Fax:508-457-4911
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1553207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00784759OtherRAILROAD MEDICARE PTAN
MAP75982Medicare UPIN
MAP00784759OtherRAILROAD MEDICARE PTAN