Healthcare Provider Details

I. General information

NPI: 1982694972
Provider Name (Legal Business Name): LAURINE L THORNTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WASHINGTON ST ATTN EMERGENCY DEPT
TAUNTON MA
02780-2465
US

IV. Provider business mailing address

460 TOTTEN POND RD C O MZI
WALTHAM MA
02451-1906
US

V. Phone/Fax

Practice location:
  • Phone: 508-828-7108
  • Fax: 508-828-7158
Mailing address:
  • Phone: 781-890-9933
  • Fax: 781-890-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number79414
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number79414
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: