MEDICARE: FRANCISCO A DE LARA SR. MD

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
1	207R00000X	Internal Medicine Physician	097457	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44150	OTHER	NY	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710989314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANCISCO A DE LARA SR. MD

Provider Business Mailing Address
First Line	:	668 COLFAX PL
Second Line	:
City	:	N WOODMERE
State	:	NY
Zip	:	11581-3006
Country	:	US
Telephone Number	:	516-791-5183
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-4516
Country	:	US
Telephone Number	:	718-342-6140
Fax Number	:	718-922-9439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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