Healthcare Provider Details

I. General information

NPI: 1215910716
Provider Name (Legal Business Name): ANNE VIRGINIA LARAIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MILL ST SUITE 310
ARLINGTON MA
02476-4784
US

IV. Provider business mailing address

22 MILL ST SUITE 310
ARLINGTON MA
02476-4784
US

V. Phone/Fax

Practice location:
  • Phone: 781-643-0500
  • Fax: 781-648-8509
Mailing address:
  • Phone: 781-643-0500
  • Fax: 781-648-8509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number215652
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number215652
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number215652
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number215652
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: