Healthcare Provider Details

I. General information

NPI: 1376105759
Provider Name (Legal Business Name): LAERCIO LOPES DA SILVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LINCOLN STREET INTERNAL MEDICINE DEPARTMENT.
FRAMINGHAM MA
01702
US

IV. Provider business mailing address

115 LINCOLN ST DEPT OF
FRAMINGHAM MA
01702-6342
US

V. Phone/Fax

Practice location:
  • Phone: 508-383-1330
  • Fax: 508-383-8582
Mailing address:
  • Phone: 802-750-1339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number110856
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number279916
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: