Provider Demographics
NPI: | 1770690141 |
---|---|
Name: | LACAVA, NICHOLAS THOMAS (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | NICHOLAS |
Middle Name: | THOMAS |
Last Name: | LACAVA |
Suffix: | |
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: | 360 W BOYLSTON ST |
Mailing Address - Street 2: | SUITE 107 |
Mailing Address - City: | WEST BOYLSTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01583-2365 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 508-854-1380 |
Mailing Address - Fax: | 508-854-0446 |
Practice Address - Street 1: | 360 W BOYLSTON ST |
Practice Address - Street 2: | SUITE 107 |
Practice Address - City: | WEST BOYLSTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01583-2365 |
Practice Address - Country: | US |
Practice Address - Phone: | 508-854-1380 |
Practice Address - Fax: | 508-854-0446 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-23 |
Last Update Date: | 2007-07-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 39891 | 207K00000X, 207QA0000X, 208000000X, 2080A0000X, 2080P0006X, 2080P0008X, 2080P0201X, 2080P0205X, 2080P0206X, 2080P0208X, 2080P0214X, 2080T0002X, 2083P0500X, 2083T0002X, 208D00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | |
Not Answered | 207QA0000X | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine |
Not Answered | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | |
Not Answered | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
Not Answered | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics |
Not Answered | 2080P0008X | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities |
Not Answered | 2080P0201X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology |
Not Answered | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
Not Answered | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
Not Answered | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
Not Answered | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
Not Answered | 2080T0002X | Allopathic & Osteopathic Physicians | Pediatrics | Medical Toxicology |
Not Answered | 2083P0500X | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine |
Not Answered | 2083T0002X | Allopathic & Osteopathic Physicians | Preventive Medicine | Medical Toxicology |
Not Answered | 208D00000X | Allopathic & Osteopathic Physicians | General Practice |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 030891 | Other | TUFTS PROVIDER ID |
MA | 2045842 | Medicaid | |
MA | E11028 | Other | BLUE CROSS PROVIDER ID |
MA | E11028 | Medicare ID - Type Unspecified | MEDICARE PROVIDER ID |
MA | E11028 | Other | BLUE CROSS PROVIDER ID |