Provider Demographics
NPI:1184793648
Name:LABARRE, ROSEANNE C (MD)
Entity type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:C
Last Name:LABARRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 MAIN STREET
Mailing Address - Street 2:STE. 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:508-754-3566
Mailing Address - Fax:508-438-6368
Practice Address - Street 1:130 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2430
Practice Address - Country:US
Practice Address - Phone:508-753-4222
Practice Address - Fax:508-753-7997
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150935207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ16664OtherBLUECROSS BLUESHIELD
MA29981OtherFALLON COMM HLTH PLAN
MA3159060Medicaid
MA65702OtherHARVARD PILGRIM
MA3159060Medicaid
MA29981OtherFALLON COMM HLTH PLAN