Provider Demographics
NPI:1073524229
Name:LAVOIE, MARSHA A (FAMILY PRACTICE)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:A
Last Name:LAVOIE
Suffix:
Gender:F
Credentials:FAMILY PRACTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SOUTH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-4051
Mailing Address - Country:US
Mailing Address - Phone:508-764-3194
Mailing Address - Fax:508-765-5458
Practice Address - Street 1:100 SOUTH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4051
Practice Address - Country:US
Practice Address - Phone:508-764-3194
Practice Address - Fax:508-765-5458
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0080097OtherEVERCARE-GROUP
MA207863801OtherUNITED HEALTHCARE
MA0006767OtherNHP-GROUP
MA1300709Medicaid
MA23618OtherCMSP
MAY02669OtherBCBS
MA0105217OtherEVERCARE
MA1300709OtherCMSP-GROUP
MA99734601OtherNETWORK HEALTH
MA0001868OtherNHP
MA7022OtherFALLON SELECT
MA70953OtherHARVARD PILGRIM
MAY10141OtherBCBS-GROUP
MA347294OtherCIGNA
MA042485308OtherNETWORK HEALTH-GROUP
MA1300709OtherCMSP-GROUP
MAY10141OtherBCBS-GROUP
MA7022OtherFALLON SELECT
MA042485308OtherNETWORK HEALTH-GROUP
MAY02669Medicare ID - Type UnspecifiedPART B