Provider Demographics
NPI:1073510756
Name:MCCANN, LAURA LINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LINDA
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:STE 300
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1711
Mailing Address - Country:US
Mailing Address - Phone:781-431-0151
Mailing Address - Fax:781-481-0152
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:STE 300
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1711
Practice Address - Country:US
Practice Address - Phone:781-431-0151
Practice Address - Fax:781-481-0152
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA483682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ02102Medicare ID - Type Unspecified
B77250Medicare UPIN