Provider Demographics
NPI:1740256247
Name:WALSH, LARA M (MD)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:M
Last Name:WALSH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:149 MAIN ST
Mailing Address - Street 2:WINTHROP PEDIATRICS & ADOLESCENT MEDICINE, STE 1A
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-1486
Mailing Address - Country:US
Mailing Address - Phone:207-377-2114
Mailing Address - Fax:207-377-6112
Practice Address - Street 1:149 MAIN ST
Practice Address - Street 2:WINTHROP PEDIATRICS & ADOLESCENT MEDINDINE, STE 1A
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-1486
Practice Address - Country:US
Practice Address - Phone:207-377-2114
Practice Address - Fax:207-377-6112
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2012-10-16
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Provider Licenses
StateLicense IDTaxonomies
ME016464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431793499Medicaid
MEUX8225Medicare PIN
ME431793499Medicaid