Healthcare Provider Details

I. General information

NPI: 1790731362
Provider Name (Legal Business Name): LORI M GARA-MATTHEWS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WALNUT ST SUITE 310
WELLESLEY HILLS MA
02481-2118
US

IV. Provider business mailing address

65 WALNUT ST SUITE 310
WELLESLEY HILLS MA
02481-2118
US

V. Phone/Fax

Practice location:
  • Phone: 781-772-1527
  • Fax: 781-772-1497
Mailing address:
  • Phone: 781-772-1527
  • Fax: 781-772-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number160021
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: