Healthcare Provider Details

I. General information

NPI: 1003812280
Provider Name (Legal Business Name): RONALD G. LAVENDA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/03/2007
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

201 HIGHLAND ST SUITE C CLINTON HOSPITAL
CLINTON MA
01510-1037
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 Number1471
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: