Basic Information
| Provider Information | |||||||||
| NPI: | 1184793648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LABARRE | ||||||||
| FirstName: | ROSEANNE | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 MAIN STREET | ||||||||
| Address2: | STE. 670 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087543566 | ||||||||
| FaxNumber: | 5084386368 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087534222 | ||||||||
| FaxNumber: | 5087537997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 12/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 150935 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 150935 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | J16664 | 01 | MD | BLUECROSS BLUESHIELD | OTHER | 29981 | 01 | MA | FALLON COMM HLTH PLAN | OTHER | 3159060 | 05 | MA | MEDICAID | 65702 | 01 | MA | HARVARD PILGRIM | OTHER |