Provider Demographics
NPI:1710989314
Name:DE LARA, FRANCISCO A SR (MD)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:A
Last Name:DE LARA
Suffix:SR
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 1:668 COLFAX PL
Mailing Address - Street 2:
Mailing Address - City:N WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3006
Mailing Address - Country:US
Mailing Address - Phone:516-791-5183
Mailing Address - Fax:
Practice Address - Street 1:1525 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4516
Practice Address - Country:US
Practice Address - Phone:718-342-6140
Practice Address - Fax:718-922-9439
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY44150OtherBCBS
NY00164301Medicaid
NY00164301Medicaid
C09955Medicare UPIN