Basic Information
| Provider Information | |||||||||
| NPI: | 1952373193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LACHIATTO | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WARREN | ||||||||
| OtherFirstName: | EMILY | ||||||||
| OtherMiddleName: | B | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 391 | ||||||||
| Address2: | INNOVATIVE PHYSICIAN SERVICES LLC | ||||||||
| City: | WILBRAHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010950391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085950531 | ||||||||
| FaxNumber: | 5088295367 | ||||||||
| Practice Location | |||||||||
| Address1: | 189 MAY ST | ||||||||
| Address2: | INNOVATIVE PHYSICIAN SERVICES LLC | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087916351 | ||||||||
| FaxNumber: | 5087532087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363A00000X | 1637 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.