Provider Demographics
NPI:1386863652
Name:OGARA, LAURA DANIEL (RD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DANIEL
Last Name:OGARA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2504
Mailing Address - Country:US
Mailing Address - Phone:617-969-9441
Mailing Address - Fax:
Practice Address - Street 1:1121 WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2149
Practice Address - Country:US
Practice Address - Phone:617-964-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA561133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALD0089OtherBCBS LDN NETWORK
MAMT0567Medicare ID - Type Unspecified