Provider Demographics
NPI:1649251778
Name:DUBUSKE, LAWRENCE M (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:DUBUSKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3926
Mailing Address - Country:US
Mailing Address - Phone:978-632-8408
Mailing Address - Fax:978-632-1573
Practice Address - Street 1:2112 F ST NW STE 501
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2704
Practice Address - Country:US
Practice Address - Phone:978-632-7361
Practice Address - Fax:978-632-1573
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47715207R00000X, 207RR0500X, 207RA0201X
DCMD038893207RA0201X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0152749Medicaid
A66516Medicare UPIN
MA0152749Medicaid