Individual
LAURAINE E DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
133 BROOKLINE AVE, ECF PROGRAM, BOSTON, MA 02215-3904
(617) 421-2686
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
50923
MA
208M00000X
Hospitalist Physician
50923
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015365
NEIGHBORHOOD HEALTH
MA
01
—
050923
TUFTS
MA
05
—
6187609
—
MA
01
—
J04151
BLUE CROSS
MA
01
—
V810
HARVARD PILGRIM
MA
Enumeration date
07/05/2006
Last updated
09/13/2016
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