Provider Demographics
NPI:1376876565
Name:WRIGHT, LAKIEA
Entity Type:Individual
Prefix:
First Name:LAKIEA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COHASSET AVE. UNIT #2
Mailing Address - Street 2:ALLERGY & ASTHMA ASSOCIATES - SOUTH
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3270
Mailing Address - Country:US
Mailing Address - Phone:508-759-7555
Mailing Address - Fax:508-759-7355
Practice Address - Street 1:33 COHASSET AVE. UNIT #2
Practice Address - Street 2:ALLERGY & ASTHMA ASSOCIATES - SOUTH
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02532-3270
Practice Address - Country:US
Practice Address - Phone:508-759-7555
Practice Address - Fax:508-759-7355
Is Sole Proprietor?:No
Enumeration Date:2009-09-07
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251373207KA0200X
IL00000000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110096022AMedicaid