Healthcare Provider Details

I. General information

NPI: 1437136413
Provider Name (Legal Business Name): LAURIE A. DIMARIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 RIVERSIDE DR
PEMBROKE MA
02359-1937
US

IV. Provider business mailing address

28 RIVERSIDE DR
PEMBROKE MA
02359-1937
US

V. Phone/Fax

Practice location:
  • Phone: 781-826-8065
  • Fax: 781-826-8043
Mailing address:
  • Phone: 781-826-8065
  • Fax: 781-826-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number75508
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: