Provider Demographics
NPI:1396745766
Name:ZUCKER, LAURA B (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:ZUCKER
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 1:11 WATER ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4812
Mailing Address - Country:US
Mailing Address - Phone:781-648-9700
Mailing Address - Fax:781-648-0234
Practice Address - Street 1:11 WATER ST
Practice Address - Street 2:STE 1A
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4812
Practice Address - Country:US
Practice Address - Phone:781-648-9700
Practice Address - Fax:781-648-0234
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA158392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2068231Medicaid
H90145Medicare UPIN
MAA35775Medicare ID - Type Unspecified