Individual
DR. LAWRENCE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2696
(202) 560-1888
Mailing address
50 FRUIT ST, BOSTON, MA 02114-2620
(202) 560-1888
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
155555
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3206611
—
MA
01
—
406931
TUFTS HEALTH PLAN
MA
01
—
J19565
BCBS MA
MA
Enumeration date
11/16/2005
Last updated
09/19/2023
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