Provider Demographics
NPI:1629099270
Name:LAROSE, STEPHEN (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:LAROSE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WESTBORO STATE HOSPITAL
Mailing Address - Street 2:288 LYMAN ST
Mailing Address - City:WESTBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01581-0288
Mailing Address - Country:US
Mailing Address - Phone:508-616-2339
Mailing Address - Fax:
Practice Address - Street 1:WESTBORO STATE HOSPITAL
Practice Address - Street 2:288 LYMAN ST
Practice Address - City:WESTBORO
Practice Address - State:MA
Practice Address - Zip Code:01581-0288
Practice Address - Country:US
Practice Address - Phone:508-616-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA864363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP1897Medicare PIN
MAP82430Medicare UPIN