Healthcare Provider Details

I. General information

NPI: 1073177721
Provider Name (Legal Business Name): LAURA ANNUNZIATA NACCARATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1699
US

IV. Provider business mailing address

2014 WASHINGTON ST
NEWTON MA
02462-1699
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6467
  • Fax: 617-243-6701
Mailing address:
  • Phone: 617-243-6467
  • Fax: 617-243-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number279892
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number328365
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: