Basic Information
| Provider Information | |||||||||
| NPI: | 1073524229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAVOIE | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | FAMILY PRACTICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 SOUTH ST | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | SOUTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015504051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087643194 | ||||||||
| FaxNumber: | 5087655458 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SOUTH ST | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | SOUTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015504051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087643194 | ||||||||
| FaxNumber: | 5087655458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 12/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 60107 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0080097 | 01 | MA | EVERCARE-GROUP | OTHER | 207863801 | 01 | MA | UNITED HEALTHCARE | OTHER | 0006767 | 01 | MA | NHP-GROUP | OTHER | 1300709 | 05 | MA | MEDICAID | 23618 | 01 | MA | CMSP | OTHER | Y02669 | 01 | MA | BCBS | OTHER | 0105217 | 01 | MA | EVERCARE | OTHER | 1300709 | 01 | MA | CMSP-GROUP | OTHER | 99734601 | 01 | MA | NETWORK HEALTH | OTHER | 0001868 | 01 | MA | NHP | OTHER | 7022 | 01 | MA | FALLON SELECT | OTHER | 70953 | 01 | MA | HARVARD PILGRIM | OTHER | Y10141 | 01 | MA | BCBS-GROUP | OTHER | 347294 | 01 | MA | CIGNA | OTHER | 042485308 | 01 | MA | NETWORK HEALTH-GROUP | OTHER |