Provider Demographics
NPI:1639195498
Name:LESAGE, HAROLD CHARLES JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:CHARLES
Last Name:LESAGE
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01747-1958
Mailing Address - Country:US
Mailing Address - Phone:508-331-0333
Mailing Address - Fax:
Practice Address - Street 1:14 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3003
Practice Address - Country:US
Practice Address - Phone:508-473-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102612367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0206OtherC.R.N.A