Provider Demographics
NPI:1376528323
Name:LAHEY, PHILIP J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:LAHEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 QUINSIGAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1806
Mailing Address - Country:US
Mailing Address - Phone:508-755-1559
Mailing Address - Fax:508-755-5640
Practice Address - Street 1:59 QUINSIGAMOND AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1806
Practice Address - Country:US
Practice Address - Phone:508-755-1559
Practice Address - Fax:508-755-5640
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2065908Medicaid
MAM09853Medicare ID - Type Unspecified
MAD04505Medicare UPIN