Provider Demographics
NPI:1861440240
Name:FLAMINIANO, LOURDES BANTING (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:BANTING
Last Name:FLAMINIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:201 HIGHLAND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-1037
Mailing Address - Country:US
Mailing Address - Phone:978-368-3870
Mailing Address - Fax:978-368-3877
Practice Address - Street 1:201 HIGHLAND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1037
Practice Address - Country:US
Practice Address - Phone:978-368-3870
Practice Address - Fax:978-368-3877
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2040492Medicaid
MAA55024Medicare UPIN
MAM15500Medicare ID - Type Unspecified