Healthcare Provider Details

I. General information

NPI: 1003022781
Provider Name (Legal Business Name): RONALD G LAVENDA DPM ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HIGHLAND ST SUITE C CLINTON HOSPITAL
CLINTON MA
01510-1037
US

IV. Provider business mailing address

39 BROWNLEA RD
FRAMINGHAM MA
01701-4253
US

V. Phone/Fax

Practice location:
  • Phone: 978-368-3990
  • Fax: 978-368-3993
Mailing address:
  • Phone: 978-368-3990
  • Fax: 978-368-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateMA

VIII. Authorized Official

Name: RONALD G. LAVENDA
Title or Position: PRESIDENT
Credential: DPM
Phone: 978-368-3990