Healthcare Provider Details

I. General information

NPI: 1770690141
Provider Name (Legal Business Name): NICHOLAS THOMAS LACAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W BOYLSTON ST SUITE 107
WEST BOYLSTON MA
01583-2365
US

IV. Provider business mailing address

360 W BOYLSTON ST SUITE 107
WEST BOYLSTON MA
01583-2365
US

V. Phone/Fax

Practice location:
  • Phone: 508-854-1380
  • Fax: 508-854-0446
Mailing address:
  • Phone: 508-854-1380
  • Fax: 508-854-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number39891
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number39891
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39891
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number39891
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number39891
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number39891
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number39891
License Number StateMA
# 8
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number39891
License Number StateMA
# 9
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number39891
License Number StateMA
# 10
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number39891
License Number StateMA
# 11
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number39891
License Number StateMA
# 12
Primary TaxonomyN
Taxonomy Code2080T0002X
TaxonomyPediatric Medical Toxicology Physician
License Number39891
License Number StateMA
# 13
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number39891
License Number StateMA
# 14
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License Number39891
License Number StateMA
# 15
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number39891
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: