Healthcare Provider Details

I. General information

NPI: 1871884395
Provider Name (Legal Business Name): LAWRENCE MARC DAGROSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE UROLOGY
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-6337
  • Fax:
Mailing address:
  • Phone: 603-650-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number18312
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: