Individual
LARA EISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
3435 MAIN ST, 252 FARBER HALL, BUFFALO, NY 14214-3001
(716) 829-6102
Mailing address
25 MORRISSEY BLVD UNIT 1130, DORCHESTER, MA 02125-3354
(716) 364-8535
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
273761
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110131572A
—
MA
01
—
S400580656
MEDICARE
MA
Enumeration date
04/28/2014
Last updated
11/14/2025
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