Healthcare Provider Details

I. General information

NPI: 1760084347
Provider Name (Legal Business Name): NATHAN LAVOIE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 1ST AVE
BOSTON MA
02129-4557
US

IV. Provider business mailing address

36 1ST AVE
BOSTON MA
02129-4557
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2947
  • Fax:
Mailing address:
  • Phone: 617-726-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: