Provider Demographics
NPI:1104880483
Name:NADLE, LUCETTE (DO)
Entity type:Individual
Prefix:
First Name:LUCETTE
Middle Name:
Last Name:NADLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:160 E MAIN ST
Mailing Address - Street 2:STE 1E
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1758
Mailing Address - Country:US
Mailing Address - Phone:508-366-9686
Mailing Address - Fax:508-366-9435
Practice Address - Street 1:160 E MAIN ST
Practice Address - Street 2:STE 1E
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1758
Practice Address - Country:US
Practice Address - Phone:508-366-9686
Practice Address - Fax:508-366-9435
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA55679204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA722313OtherTUFTS HEALTH PLAN
MAAA6781OtherHARVARD PILGRIM HEALTHCAR
MA9731041Medicaid
MAJ08035OtherBLUE CROSS/BLUE SHIELD
MA722313OtherTUFTS HEALTH PLAN
MA9731041Medicaid