Healthcare Provider Details

I. General information

NPI: 1386863652
Provider Name (Legal Business Name): LAURA DANIEL OGARA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 WASHINGTON ST SUITE 4
WEST NEWTON MA
02465-2149
US

IV. Provider business mailing address

6 FOREST AVE
WEST NEWTON MA
02465-2504
US

V. Phone/Fax

Practice location:
  • Phone: 617-964-1716
  • Fax:
Mailing address:
  • Phone: 617-969-9441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number561
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: