Provider Demographics
NPI:1295700813
Name:LACHANCE, DAVID J (APRN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:LACHANCE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1836
Mailing Address - Country:US
Mailing Address - Phone:860-928-6541
Mailing Address - Fax:
Practice Address - Street 1:35 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1939
Practice Address - Country:US
Practice Address - Phone:860-963-3883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223326363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
4142199OtherMVP HEALTH CARE
77213OtherHEALTHY START
0702706OtherMEDICAID WELFARE
77213OtherCHILDRENS MEDICAL SECURIT
AA19499OtherHARVARD PILGRIM HEALTHCAR
NP4788OtherMEDICARE B
042472266OtherTHREE RIVERS
MA0727706Medicaid
93026OtherFALLON COMMUNITY HEALTH P
042472266OtherPRIVATE HEALTHCARE SYSTEM