Basic Information
Provider Information | |||||||||
NPI: | 1992964183 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MACLACHLAN | ||||||||
FirstName: | LARA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SUH | ||||||||
OtherFirstName: | LARA | ||||||||
OtherMiddleName: | K | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 41 MALL RD | ||||||||
Address2: | LAHEY CLINIC | ||||||||
City: | BURLINGTON | ||||||||
State: | MA | ||||||||
PostalCode: | 018050001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7817448000 | ||||||||
FaxNumber: | 7817445429 | ||||||||
Practice Location | |||||||||
Address1: | 41 MALL RD | ||||||||
Address2: | LAHEY CLINIC | ||||||||
City: | BURLINGTON | ||||||||
State: | MA | ||||||||
PostalCode: | 018050001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7817448000 | ||||||||
FaxNumber: | 7817445429 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/03/2008 | ||||||||
LastUpdateDate: | 07/17/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 208800000X | 35538 | SC | N |   | Allopathic & Osteopathic Physicians | Urology |   | 208800000X | 259192 | MA | Y |   | Allopathic & Osteopathic Physicians | Urology |   | 208800000X | 16595 | NH | N |   | Allopathic & Osteopathic Physicians | Urology |   |
No ID Information.