Provider Demographics
NPI:1215386800
Name:SMITH, LARA ENID (MD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:ENID
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 STATE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-2906
Mailing Address - Country:US
Mailing Address - Phone:617-505-1520
Mailing Address - Fax:
Practice Address - Street 1:109 STATE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2903
Practice Address - Country:US
Practice Address - Phone:617-505-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPME4914207Q00000X
IL036167275207Q00000X
GA78755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine