Provider Demographics
NPI:1568454361
Name:LAREAU, GREGORY JOHN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
Last Name:LAREAU
Suffix:
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 1:1681 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-7948
Mailing Address - Country:US
Mailing Address - Phone:781-335-4815
Mailing Address - Fax:781-337-9654
Practice Address - Street 1:1681 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-7948
Practice Address - Country:US
Practice Address - Phone:781-335-4815
Practice Address - Fax:781-337-9654
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75011208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ1169202Medicaid
MA3083705Medicaid
MA3083705Medicaid