Healthcare Provider Details

I. General information

NPI: 1407907553
Provider Name (Legal Business Name): LARA FORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 LINCOLN ST MEDICAL STAFF SVCS
WORCESTER MA
01605-2138
US

IV. Provider business mailing address

86 DEXTER AVE APT 3
WATERTOWN MA
02472-4230
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-8015
  • Fax:
Mailing address:
  • Phone: 857-389-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number222427
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: