Provider Demographics
NPI:1750894507
Name:ROSA, LAUREN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MAZZOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:395 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3914
Mailing Address - Country:US
Mailing Address - Phone:413-584-7787
Mailing Address - Fax:413-341-1620
Practice Address - Street 1:395 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3914
Practice Address - Country:US
Practice Address - Phone:413-584-7787
Practice Address - Fax:413-341-1620
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine