Provider Demographics
NPI:1710939129
Name:TREMBLAY, LAURA D (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-325-2800
Practice Address - Fax:617-541-7500
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA206062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHV0132OtherHARVARD PILGRIM
MAJ23035OtherBLUE CROSS
MA206062OtherTUFTS
MA0021751OtherNEIGHBORHOOD HEALTH
MA0104451Medicaid
MA0104451Medicaid
MAHV0132OtherHARVARD PILGRIM