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NPI Code Detail

MEDICARE: RONALD G. LAVENDA DPM

MEDICARE: RONALD G. LAVENDA DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0131XFoot Surgery Podiatrist1471MA

General Provider Information

NPI Number : 1003812280
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD G. LAVENDA DPM
Provider Business Mailing Address
First Line : 201 HIGHLAND ST
Second Line : SUITE C CLINTON HOSPITAL
City : CLINTON
State : MA
Zip : 01510-1037
Country : US
Telephone Number : 978-368-3990
Fax Number : 978-368-3993
Provider Business Practice Location Address
First Line : 201 HIGHLAND ST
Second Line : SUITE C CLINTON HOSPITAL
City : CLINTON
State : MA
Zip : 01510-1037
Country : US
Telephone Number : 978-368-3990
Fax Number : 978-368-3993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 12/03/2007

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