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NPI Code Detail

MEDICARE: DR. CLEMENT EMERY LACOSTE MD

MEDICARE: DR. CLEMENT EMERY LACOSTE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician26014MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508877630
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLEMENT EMERY LACOSTE MD
Provider Business Mailing Address
First Line : 105 COUNTRY CLUB PL
Second Line :
City : SOUTHBRIDGE
State : MA
Zip : 01550
Country : US
Telephone Number : 508-764-6026
Fax Number : 508-764-7866
Provider Business Practice Location Address
First Line : 10 N MAIN ST
Second Line :
City : CHARLTON
State : MA
Zip : 01507-1590
Country : US
Telephone Number : 508-248-6780
Fax Number : 508-248-8134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 08/23/2012

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Directions to “ DR. CLEMENT EMERY LACOSTE MD” Practice Location

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