Provider Demographics
NPI:1578020319
Name:BALDUCCI, LAURA M (MAOM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:BALDUCCI
Suffix:
Gender:F
Credentials:MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GALE ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-6001
Mailing Address - Country:US
Mailing Address - Phone:978-870-0750
Mailing Address - Fax:
Practice Address - Street 1:11 GALE ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-6001
Practice Address - Country:US
Practice Address - Phone:978-870-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist