Provider Demographics
NPI:1154496982
Name:RASLAVICUS, SONJA K (DO)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:K
Last Name:RASLAVICUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1756
Mailing Address - Country:US
Mailing Address - Phone:978-557-8800
Mailing Address - Fax:978-557-8633
Practice Address - Street 1:370 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1788
Practice Address - Country:US
Practice Address - Phone:978-557-8800
Practice Address - Fax:978-557-8633
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12536207P00000X
MA217591207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30223368Medicaid
P00196623OtherRAILROAD MEDICARE
000000042885OtherBMC HEALTHNET PLAN
MA2099080Medicaid
AA25559OtherHARVARD PILGRIM
NH04Y005461MA02OtherANTHEM
ME432620899Medicaid
NH30223368Medicaid
000000042885OtherBMC HEALTHNET PLAN
ME432620899Medicaid