Provider Demographics
NPI:1275718934
Name:LUCETTE NADLE DO
Entity Type:Organization
Organization Name:LUCETTE NADLE DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NADLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:508-366-9686
Mailing Address - Street 1:160 E MAIN ST
Mailing Address - Street 2:STE 1E
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1758
Mailing Address - Country:US
Mailing Address - Phone:508-366-9686
Mailing Address - Fax:508-366-9435
Practice Address - Street 1:160 E MAIN ST
Practice Address - Street 2:STE 1E
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1758
Practice Address - Country:US
Practice Address - Phone:508-366-9686
Practice Address - Fax:508-366-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55679204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9731041Medicaid
MAM19169OtherMA BLUE SHIELD