Healthcare Provider Details

I. General information

NPI: 1649349796
Provider Name (Legal Business Name): LAURA ELIZABETH CONNOLLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELIZABETH DEMARCO MD

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LINCOLN ST
FRAMINGHAM MA
01702
US

IV. Provider business mailing address

115 LINCOLN ST
FRAMINGHAM MA
01702
US

V. Phone/Fax

Practice location:
  • Phone: 508-383-1104
  • Fax:
Mailing address:
  • Phone: 508-383-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number230507
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: