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NPI Code Detail

MEDICARE: NANCY C LASSON D.O.

MEDICARE: NANCY C LASSON D.O.
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
1207R00000XInternal Medicine PhysicianDO00867RI

General Provider Information

NPI Number : 1679572390
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY C LASSON D.O.
Provider Business Mailing Address
First Line : 455 TOLL GATE RD
Second Line : PRC AND CREDENTIALING
City : WARWICK
State : RI
Zip : 02886-2759
Country : US
Telephone Number : 401-273-0641
Fax Number : 401-273-2919
Provider Business Practice Location Address
First Line : 1195 NORTH MAIN STREET
Second Line : CNEMG PRIMARY CARE WMC
City : PROVIDENCE
State : RI
Zip : 02904-0288
Country : US
Telephone Number : 401-736-4562
Fax Number : 401-921-9864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 03/19/2025

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