Provider Demographics
NPI:1154302503
Name:CRAIN, LAURA DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:DIANE
Last Name:CRAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:264 BEACON ST FL 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1236
Mailing Address - Country:US
Mailing Address - Phone:617-867-0343
Mailing Address - Fax:617-867-0002
Practice Address - Street 1:264 BEACON ST FL 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1236
Practice Address - Country:US
Practice Address - Phone:617-867-0343
Practice Address - Fax:617-867-0002
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA723682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA724238OtherTUFTS HEALTH PLAN
E62304Medicare UPIN
MA724238OtherTUFTS HEALTH PLAN