Provider Demographics
NPI:1437136413
Name:DIMARIA, LAURIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:A
Last Name:DIMARIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1937
Mailing Address - Country:US
Mailing Address - Phone:781-826-8065
Mailing Address - Fax:781-826-8043
Practice Address - Street 1:28 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1937
Practice Address - Country:US
Practice Address - Phone:781-826-8065
Practice Address - Fax:781-826-8043
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA710638OtherHARVARD PILGRIM
MA3098915Medicaid
MAJ12414OtherBLUE CROSS BLUE SHIELD
MA075508OtherTUFTS HEALTH PLAN
MAF27005Medicare UPIN
MAJ12414Medicare PIN
MABX8629Medicare PIN