Provider Demographics
NPI:1265414296
Name:LAFRANCO, THERESA A (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:A
Last Name:LAFRANCO
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 1:1837 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-2121
Mailing Address - Country:US
Mailing Address - Phone:570-253-5838
Mailing Address - Fax:570-253-1245
Practice Address - Street 1:62 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436
Practice Address - Country:US
Practice Address - Phone:570-689-7565
Practice Address - Fax:570-689-4803
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05693000208000000X
PAMD042543E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014813550005Medicaid
PA0014813550006Medicaid
PA0014813550007Medicaid
PA0014813550003Medicaid