Healthcare Provider Details

I. General information

NPI: 1407035116
Provider Name (Legal Business Name): RONALD G LAVENDA DPM ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date: 02/26/2009
Reactivation Date: 05/11/2009

III. Provider practice location address

202 W CENTER ST
WEST BRIDGEWATER MA
02379
US

IV. Provider business mailing address

39 BROWNLEA RD
FRAMINGHAM MA
01701-4253
US

V. Phone/Fax

Practice location:
  • Phone: 508-580-1368
  • Fax:
Mailing address:
  • Phone: 508-580-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateMA

VIII. Authorized Official

Name: RONALD G LAVENDA
Title or Position: PRESIDENT
Credential: DPM
Phone: 508-580-1368