Provider Demographics
NPI:1407035116
Name:RONALD G LAVENDA DPM ASSOCIATES PC
Entity Type:Organization
Organization Name:RONALD G LAVENDA DPM ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAVENDA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-580-1368
Mailing Address - Street 1:39 BROWNLEA RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4253
Mailing Address - Country:US
Mailing Address - Phone:508-580-1368
Mailing Address - Fax:
Practice Address - Street 1:202 W CENTER ST
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379
Practice Address - Country:US
Practice Address - Phone:508-580-1368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RONALD G LAVENDA DPM ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-30
Last Update Date:2009-05-11
Deactivation Date:2009-02-26
Deactivation Code:
Reactivation Date:2009-05-11
Provider Licenses
StateLicense IDTaxonomies
MA213ES0131X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9737014Medicaid
MAY77031OtherBSBC
MA0561100002Medicare NSC