MEDICARE: DR. EDUARDO K LACSON JR. M.D., M.P.H.

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
1	207RN0300X	Nephrology Physician	157079	MA

General Provider Information

NPI Number	:	1962507921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARDO K LACSON JR. M.D., M.P.H.

Provider Business Mailing Address
First Line	:	365 WOBURN ST
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-2306
Country	:	US
Telephone Number	:	781-402-9000
Fax Number	:	781-402-4635

Provider Business Practice Location Address
First Line	:	95 HAYDEN AVE
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02421-7942
Country	:	US
Telephone Number	:	781-402-9000
Fax Number	:	781-402-4635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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