Individual
LAURA MARIE BEVILACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6793
Mailing address
PO BOX 9135, ATT:SHARON SILVA, BROOKLINE, MA 02446-9135
(603) 890-4404
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
155889
MA
208000000X
Pediatrics Physician
155889
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003136000
—
CT
05
—
2357326
—
NY
05
—
30201468
—
NH
05
—
3198235
—
MA
01
—
75-00451
UNITED HEALTHCARE MA
MA
05
—
8753709
—
NJ
01
—
99487301
NETWORK HEALTH
MA
01
—
AA9205
HARVARD PILGRIM
MA
01
—
J21189
BCBS MA
MA
05
—
LB45398
—
RI
Enumeration date
10/14/2005
Last updated
09/22/2020
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