MEDICARE: DR. THOMAS GEORGE LAREAU M.D.

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	207P00000X	Emergency Medicine Physician	159091	MA
2	207Q00000X	Family Medicine Physician	34658	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	J21000	OTHER	MA	BLUE SHEILD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871580035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS GEORGE LAREAU M.D.

Provider Business Mailing Address
First Line	:	27 VALE RD
Second Line	:
City	:	WAKEFIELD
State	:	MA
Zip	:	01880-4333
Country	:	US
Telephone Number	:	781-621-8346
Fax Number	:	561-892-8501

Provider Business Practice Location Address
First Line	:	133 ORNAC
Second Line	:
City	:	CONCORD
State	:	MA
Zip	:	01742-4159
Country	:	US
Telephone Number	:	978-287-3690
Fax Number	:

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	05/05/2008

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