Provider Demographics
NPI:1790926509
Name:LEARY, LAURA MARIE (PSGT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:LEARY
Suffix:
Gender:F
Credentials:PSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CUSHING ST
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3709
Mailing Address - Country:US
Mailing Address - Phone:781-706-4732
Mailing Address - Fax:781-875-1067
Practice Address - Street 1:412 CUSHING ST
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3709
Practice Address - Country:US
Practice Address - Phone:781-706-4732
Practice Address - Fax:781-875-1067
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory