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Individual
LUCAS RABENO FASOLO
Active
Individual
LUCAS RABENO FASOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
264115
MA
207R00000X
Internal Medicine Physician
277164
MA
207R00000X
Internal Medicine Physician
Primary
ME152888
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
237221597
—
MA
Enumeration date
06/29/2015
Last updated
10/29/2021
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