Individual
LAURA LIEDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16 GOULD AVE UNIT 1, MALDEN, MA 02148-6913
(858) 245-5987
Mailing address
136 HARRISON AVE # M&V510, BOSTON, MA 02111-1817
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
03/02/2023
Last updated
05/14/2024
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