Doctor Name: | STEPHEN LAROSE |
NPI Number: | 1629099270 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 864 |
Business Practice Address: | Westboro State Hospital 288 Lyman St Westboro, MA - 015810288 |
Business Phone Number: | 5086162339 |
Business Fax Number: | |
Mailing Address: | Westboro State Hospital, 288 Lyman St WESTBORO |
State: | MA |
Postal Code: | 015810288 |
Phone Number: | 5086162339 |
Fax Number: | |
NPI Enumeration Date: | 07/21/2006 |
NPI Last Update Date: | 07/18/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 864 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |