Provider Demographics
NPI:1932190592
Name:BRAND, LAURA R (PAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:BRAND
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3300
Mailing Address - Country:US
Mailing Address - Phone:508-553-9145
Mailing Address - Fax:508-520-3167
Practice Address - Street 1:620 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3300
Practice Address - Country:US
Practice Address - Phone:508-553-9145
Practice Address - Fax:508-520-3167
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7902084P0800X
MA790364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA790OtherCOMM MN PHYSICIANS ASST