Provider Demographics
NPI:1922174564
Name:MEADE, LARRY NIS (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:NIS
Last Name:MEADE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1309
Mailing Address - Country:US
Mailing Address - Phone:508-835-6221
Mailing Address - Fax:508-835-4859
Practice Address - Street 1:9 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1309
Practice Address - Country:US
Practice Address - Phone:508-835-6221
Practice Address - Fax:508-835-4859
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine