Provider Demographics
NPI:1285623280
Name:LAMONT, BARRY MICHAEL (MD, CM)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:MICHAEL
Last Name:LAMONT
Suffix:
Gender:M
Credentials:MD, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ANDERER LN
Mailing Address - Street 2:UNIT 1
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2229
Mailing Address - Country:US
Mailing Address - Phone:617-325-3736
Mailing Address - Fax:
Practice Address - Street 1:100 ANDERER LN
Practice Address - Street 2:UNIT 1
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-2229
Practice Address - Country:US
Practice Address - Phone:617-325-3736
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC233012085R0202X
NY14616512085R0202X
MA719172085R0202X
CT0381872085R0202X
ME0153352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3057186Medicaid
B72346Medicare UPIN
MAJ09273Medicare ID - Type Unspecified