Provider Demographics
NPI:1770690141
Name:LACAVA, NICHOLAS THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:LACAVA
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 1:360 W BOYLSTON ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-2365
Mailing Address - Country:US
Mailing Address - Phone:508-854-1380
Mailing Address - Fax:508-854-0446
Practice Address - Street 1:360 W BOYLSTON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2365
Practice Address - Country:US
Practice Address - Phone:508-854-1380
Practice Address - Fax:508-854-0446
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39891207K00000X, 207QA0000X, 208000000X, 2080A0000X, 2080P0006X, 2080P0008X, 2080P0201X, 2080P0205X, 2080P0206X, 2080P0208X, 2080P0214X, 2080T0002X, 2083P0500X, 2083T0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical Toxicology
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA030891OtherTUFTS PROVIDER ID
MA2045842Medicaid
MAE11028OtherBLUE CROSS PROVIDER ID
MAE11028Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
MAE11028OtherBLUE CROSS PROVIDER ID